Provider Demographics
NPI:1316030430
Name:WHITMORE, CHERYL CLAIRE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:CLAIRE
Last Name:WHITMORE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 S MAIN ST
Mailing Address - Street 2:AGAPE COUNSELING CENTER
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45458
Mailing Address - Country:US
Mailing Address - Phone:937-434-0540
Mailing Address - Fax:937-434-6726
Practice Address - Street 1:175 S MAIN ST
Practice Address - Street 2:AGAPE COUNSELING CENTER
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45458
Practice Address - Country:US
Practice Address - Phone:937-434-0540
Practice Address - Fax:937-434-6726
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4401103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CP10542Medicare ID - Type Unspecified