Provider Demographics
NPI:1558044149
Name:CHERRY, MYCALA (MS, APC, NCC)
Entity Type:Individual
Prefix:
First Name:MYCALA
Middle Name:
Last Name:CHERRY
Suffix:
Gender:F
Credentials:MS, APC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:889 WIMPY MILL RD
Mailing Address - Street 2:
Mailing Address - City:DAHLONEGA
Mailing Address - State:GA
Mailing Address - Zip Code:30533-0492
Mailing Address - Country:US
Mailing Address - Phone:734-652-4566
Mailing Address - Fax:
Practice Address - Street 1:889 WIMPY MILL RD
Practice Address - Street 2:
Practice Address - City:DAHLONEGA
Practice Address - State:GA
Practice Address - Zip Code:30533-0492
Practice Address - Country:US
Practice Address - Phone:734-652-4566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC006827101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional