Provider Demographics
NPI:1073133849
Name:HARRISON, CHERYL ANN (TCADC, TPSS)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:ANN
Last Name:HARRISON
Suffix:
Gender:F
Credentials:TCADC, TPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MAYSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41056-1120
Mailing Address - Country:US
Mailing Address - Phone:505-402-8963
Mailing Address - Fax:
Practice Address - Street 1:901 US HIGHWAY 68 STE 900
Practice Address - Street 2:
Practice Address - City:MAYSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41056-9190
Practice Address - Country:US
Practice Address - Phone:937-213-1792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-22
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY175T00000X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist