Provider Demographics
NPI:1518135961
Name:BLEVINS, CHERYL JEAN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:JEAN
Last Name:BLEVINS
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 1:4920 ATLANTA HWY STE 114
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-2921
Mailing Address - Country:US
Mailing Address - Phone:678-491-4681
Mailing Address - Fax:
Practice Address - Street 1:4920 ATLANTA HWY STE 114
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-2921
Practice Address - Country:US
Practice Address - Phone:678-491-4681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0036051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical