Provider Demographics
NPI:1487294278
Name:PERRY, CHERYL M
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:M
Last Name:PERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2533 LAKEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-3703
Mailing Address - Country:US
Mailing Address - Phone:757-717-3179
Mailing Address - Fax:757-337-0019
Practice Address - Street 1:2533 LAKEWOOD LN
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-3703
Practice Address - Country:US
Practice Address - Phone:757-717-3179
Practice Address - Fax:757-337-0019
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-09
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040112191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical