Provider Demographics
NPI: | 1265861116 |
---|---|
Name: | PRESSLEY-CHEATHAM, SHERRY R (LPC) |
Entity Type: | Individual |
Prefix: | |
First Name: | SHERRY |
Middle Name: | R |
Last Name: | PRESSLEY-CHEATHAM |
Suffix: | |
Gender: | F |
Credentials: | LPC |
Other - Prefix: | |
Other - First Name: | SHERRY |
Other - Middle Name: | |
Other - Last Name: | PRESSLEY |
Other - Suffix: | |
Other - Last Name Type: | Former Name |
Other - Credentials: | |
Mailing Address - Street 1: | 410 UNIVERSITY PKWY |
Mailing Address - Street 2: | SUITE 2300 |
Mailing Address - City: | AIKEN |
Mailing Address - State: | SC |
Mailing Address - Zip Code: | 29801-6807 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 803-335-1219 |
Mailing Address - Fax: | 803-335-1689 |
Practice Address - Street 1: | 410 UNIVERSITY PKWY |
Practice Address - Street 2: | SUITE 2300 |
Practice Address - City: | AIKEN |
Practice Address - State: | SC |
Practice Address - Zip Code: | 29801-6807 |
Practice Address - Country: | US |
Practice Address - Phone: | 803-335-1219 |
Practice Address - Fax: | 803-335-1689 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2013-11-01 |
Last Update Date: | 2015-02-05 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
SC | 5426 | 101YP2500X |
101YM0800X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
SC | 5426 | Medicaid |