Provider Demographics
NPI:1083319875
Name:HARRELL BRINKLEY, CHERYL DELORES (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:DELORES
Last Name:HARRELL BRINKLEY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3406 SPRING CHASE LN
Mailing Address - Street 2:
Mailing Address - City:ELLENWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30294-1379
Mailing Address - Country:US
Mailing Address - Phone:404-642-4334
Mailing Address - Fax:
Practice Address - Street 1:3406 SPRING CHASE LN
Practice Address - Street 2:
Practice Address - City:ELLENWOOD
Practice Address - State:GA
Practice Address - Zip Code:30294-1379
Practice Address - Country:US
Practice Address - Phone:404-642-4334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC002718101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty