Provider Demographics
NPI:1104368984
Name:CHERYL A. KORB, LLC
Entity Type:Organization
Organization Name:CHERYL A. KORB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:A
Authorized Official - Last Name:OCONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:404-919-7334
Mailing Address - Street 1:327 DAHLONEGA STREET SUITE 901A
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-9229
Mailing Address - Country:US
Mailing Address - Phone:404-919-7334
Mailing Address - Fax:
Practice Address - Street 1:327 DAHLONEGA STREET SUITE 901A
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-9229
Practice Address - Country:US
Practice Address - Phone:404-919-7334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-10
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008091101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty