Provider Demographics
NPI:1093227100
Name:FORBY, CHERYL
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:FORBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2624 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45505-2607
Mailing Address - Country:US
Mailing Address - Phone:937-328-5300
Mailing Address - Fax:937-922-4900
Practice Address - Street 1:2624 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45505-2607
Practice Address - Country:US
Practice Address - Phone:937-328-5300
Practice Address - Fax:937-922-4900
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-30
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLCDCII.021357-2101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)