Provider Demographics
NPI:1437391398
Name:FORDHAM, CHERYL L (MS, LPC, NBCCH)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:L
Last Name:FORDHAM
Suffix:
Gender:F
Credentials:MS, LPC, NBCCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3482 KEITH BRIDGE RD
Mailing Address - Street 2:SUITE 316
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-5546
Mailing Address - Country:US
Mailing Address - Phone:404-547-0235
Mailing Address - Fax:
Practice Address - Street 1:634 PEACHTREE PKWY
Practice Address - Street 2:SUITE 250
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-9782
Practice Address - Country:US
Practice Address - Phone:404-547-0235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-24
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001953101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional