Provider Demographics
NPI:1477932853
Name:BRAVO, CHERYL ANNE (LCSW)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:ANNE
Last Name:BRAVO
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:PO BOX 973
Mailing Address - Street 2:
Mailing Address - City:HAYESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28904-0973
Mailing Address - Country:US
Mailing Address - Phone:828-283-0569
Mailing Address - Fax:770-995-1959
Practice Address - Street 1:3280 NC HIGHWAY 69 #4E
Practice Address - Street 2:
Practice Address - City:HAYESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28904-6952
Practice Address - Country:US
Practice Address - Phone:282-830-5698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-19
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0115451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty