Provider Demographics
NPI:1518694835
Name:CHERRY, TAMEKA NICOLE
Entity Type:Individual
Prefix:
First Name:TAMEKA
Middle Name:NICOLE
Last Name:CHERRY
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:PO BOX 804
Mailing Address - Street 2:
Mailing Address - City:AHOSKIE
Mailing Address - State:NC
Mailing Address - Zip Code:27910-0804
Mailing Address - Country:US
Mailing Address - Phone:252-332-2297
Mailing Address - Fax:252-332-2416
Practice Address - Street 1:125 W BELLE ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-4503
Practice Address - Country:US
Practice Address - Phone:252-572-4148
Practice Address - Fax:252-572-4222
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-28454101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)