Provider Demographics
NPI:1407107543
Name:CHERRY, BATHSHEBA C (LPC)
Entity Type:Individual
Prefix:
First Name:BATHSHEBA
Middle Name:C
Last Name:CHERRY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2103 POINSETT WAY
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-5506
Mailing Address - Country:US
Mailing Address - Phone:912-695-7736
Mailing Address - Fax:
Practice Address - Street 1:2103 POINSETT WAY
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-5506
Practice Address - Country:US
Practice Address - Phone:912-695-7736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-28
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1247101YA0400X
101YA0400X, 101YM0800X
GALPC010686101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)