Provider Demographics
NPI:1548684145
Name:WEISEND, CHERARAE (LPCC)
Entity type:Individual
Prefix:MS
First Name:CHERARAE
Middle Name:
Last Name:WEISEND
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3769 CASCADES BLVD APT 312
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-8043
Mailing Address - Country:US
Mailing Address - Phone:330-221-8226
Mailing Address - Fax:
Practice Address - Street 1:3769 CASCADES BLVD APT 312
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-8043
Practice Address - Country:US
Practice Address - Phone:330-221-8226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-18
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1300034101YP2500X
OHE.1300034101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2871101Medicaid