Provider Demographics
NPI:1275508046
Name:NUCKOLS, CHERIE G (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CHERIE
Middle Name:G
Last Name:NUCKOLS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6851 COURTHOUSE RD STE 300
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-5308
Mailing Address - Country:US
Mailing Address - Phone:804-715-3215
Mailing Address - Fax:804-715-3233
Practice Address - Street 1:6851 COURTHOUSE RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-5308
Practice Address - Country:US
Practice Address - Phone:804-715-3215
Practice Address - Fax:804-715-3233
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040037641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA19962400OtherMAGELLAN
VA7355625OtherAETNA
VA089680MOtherOPTIMA/SENTERA/SOUTHERN H
VA300191855OtherUNITED BEHAVIORAL HEALTH
VA345976OtherMHN
VA010120730Medicaid
VA487110OtherVALUE OPTIONS
VA138146OtherANTHEM
VA2133877OtherMAMSI
VA300191855OtherPHCS
VA238857OtherCOMPPSYCH
VA010120730Medicaid