Provider Demographics
NPI:1396183273
Name:HOLLINGSWORTH, CHERYL RENEE (RN, CADAC II)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:RENEE
Last Name:HOLLINGSWORTH
Suffix:
Gender:F
Credentials:RN, CADAC II
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Mailing Address - Street 1:114 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-3207
Mailing Address - Country:US
Mailing Address - Phone:574-533-6154
Mailing Address - Fax:574-534-3951
Practice Address - Street 1:204 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46516-3120
Practice Address - Country:US
Practice Address - Phone:574-293-1086
Practice Address - Fax:574-522-7461
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
101YA0400X
IN28125454A163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)