Provider Demographics
NPI:1124026596
Name:CHERICH, CAROL JEAN (LPC-LADAC)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:JEAN
Last Name:CHERICH
Suffix:
Gender:F
Credentials:LPC-LADAC
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:JEAN
Other - Last Name:CHERICH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC-LADAC
Mailing Address - Street 1:4401 S COULTER ST APT 1913
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-5068
Mailing Address - Country:US
Mailing Address - Phone:505-870-1855
Mailing Address - Fax:
Practice Address - Street 1:4401 S COULTER ST APT 1913
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-5068
Practice Address - Country:US
Practice Address - Phone:505-870-1855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0089181101YA0400X
NM0101181101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1124026596Medicaid