Provider Demographics
NPI:1518692490
Name:NICHOLSON, CHERYL LYNN
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:LYNN
Last Name:NICHOLSON
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 1:115 SUNNYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-3421
Mailing Address - Country:US
Mailing Address - Phone:864-344-1249
Mailing Address - Fax:
Practice Address - Street 1:115 SUNNYSIDE DR
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-3421
Practice Address - Country:US
Practice Address - Phone:864-344-1249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-23
Last Update Date:2022-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
111111111OtherNON SPECIFIED