Provider Demographics
NPI:1831270743
Name:GANSER, CHERYL (MA, LISW-CP)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:GANSER
Suffix:
Gender:F
Credentials:MA, LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 MAIN ST STE 100A13
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29926-4629
Mailing Address - Country:US
Mailing Address - Phone:704-540-0802
Mailing Address - Fax:
Practice Address - Street 1:400 MAIN ST STE 100A13
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-4629
Practice Address - Country:US
Practice Address - Phone:704-540-0802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490081821041C0700X
NCC0053411041C0700X
SC153551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical