Provider Demographics
NPI:1437451630
Name:CHEATHAM, LORNA DENISE
Entity Type:Individual
Prefix:MS
First Name:LORNA
Middle Name:DENISE
Last Name:CHEATHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:481 VIRGINIA CT
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-3973
Mailing Address - Country:US
Mailing Address - Phone:734-777-3914
Mailing Address - Fax:
Practice Address - Street 1:481 VIRGINIA CT
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-3973
Practice Address - Country:US
Practice Address - Phone:734-777-3914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-22
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAF820287622101YM0800X
MIAS820283908101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health