Provider Demographics
NPI:1780960591
Name:ANDERSON, CHERI (MED, LPC, RPT, NCC)
Entity type:Individual
Prefix:
First Name:CHERI
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MED, LPC, RPT, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3485 KENNEDY BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:REGISTER
Mailing Address - State:GA
Mailing Address - Zip Code:30452-3911
Mailing Address - Country:US
Mailing Address - Phone:912-531-0669
Mailing Address - Fax:
Practice Address - Street 1:326 MYRTLE CROSSING DR STE 100
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-4689
Practice Address - Country:US
Practice Address - Phone:912-531-0669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-25
Last Update Date:2020-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006540101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional