Provider Demographics
NPI:1407929763
Name:HENRY, CHERI (LCSW)
Entity Type:Individual
Prefix:
First Name:CHERI
Middle Name:
Last Name:HENRY
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 1:1912 EASTCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-3501
Mailing Address - Country:US
Mailing Address - Phone:336-814-2915
Mailing Address - Fax:336-884-9518
Practice Address - Street 1:1912 EASTCHESTER DR STE 204
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-3505
Practice Address - Country:US
Practice Address - Phone:336-814-2915
Practice Address - Fax:336-884-9518
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
C005831101YM0800X
NCC0058311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6106803Medicaid