Provider Demographics
NPI:1114207156
Name:JORGENSEN, CHERYL (LMHC)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:JORGENSEN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 KEAWE ST
Mailing Address - Street 2:SUITE 204J, BOX 232
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2874
Mailing Address - Country:US
Mailing Address - Phone:808-935-9396
Mailing Address - Fax:808-935-9996
Practice Address - Street 1:120 KEAWE ST
Practice Address - Street 2:SUITE 204J, BOX 232
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2874
Practice Address - Country:US
Practice Address - Phone:808-935-9396
Practice Address - Fax:808-935-9996
Is Sole Proprietor?:No
Enumeration Date:2011-08-22
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMHC324101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health