Provider Demographics
NPI:1043677123
Name:DELUCA-JOHNSON, CHERYL (LPC 004168)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:DELUCA-JOHNSON
Suffix:
Gender:F
Credentials:LPC 004168
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2022 FOREST HILL CT
Mailing Address - Street 2:
Mailing Address - City:BRASELTON
Mailing Address - State:GA
Mailing Address - Zip Code:30517-4065
Mailing Address - Country:US
Mailing Address - Phone:678-300-6297
Mailing Address - Fax:
Practice Address - Street 1:2022 FOREST HILL CT
Practice Address - Street 2:
Practice Address - City:BRASELTON
Practice Address - State:GA
Practice Address - Zip Code:30517-4065
Practice Address - Country:US
Practice Address - Phone:678-300-6297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-21
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004168101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional