Provider Demographics
NPI:1508110925
Name:CHILDERS, CHERYL (LISW-CP, LPC, ATR-BC)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:CHILDERS
Suffix:
Gender:F
Credentials:LISW-CP, LPC, ATR-BC
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:
Other - Last Name:STOTTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:52 SAINT MARK RD
Mailing Address - Street 2:
Mailing Address - City:TAYLORS
Mailing Address - State:SC
Mailing Address - Zip Code:29687-5233
Mailing Address - Country:US
Mailing Address - Phone:864-501-3633
Mailing Address - Fax:
Practice Address - Street 1:52 SAINT MARK RD
Practice Address - Street 2:
Practice Address - City:TAYLORS
Practice Address - State:SC
Practice Address - Zip Code:29687-5233
Practice Address - Country:US
Practice Address - Phone:864-501-3633
Practice Address - Fax:864-501-3633
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-07
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9476104100000X, 1041C0700X
AK1771351041C0700X
NCC0101371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC47-2293546OtherEIN