Provider Demographics
NPI:1598932857
Name:YAKAVONIS, CHERYL LEE (NCC, LPC)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:LEE
Last Name:YAKAVONIS
Suffix:
Gender:F
Credentials:NCC, LPC
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 261
Mailing Address - Street 2:
Mailing Address - City:TANNERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18372-0261
Mailing Address - Country:US
Mailing Address - Phone:570-213-2817
Mailing Address - Fax:
Practice Address - Street 1:115 LEARN RD FL 2
Practice Address - Street 2:
Practice Address - City:TANNERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18372-7951
Practice Address - Country:US
Practice Address - Phone:570-213-2817
Practice Address - Fax:855-244-2286
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-14
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC004848101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1033764220001OtherPROMISE PROVIDER ID (CHIP ONLY)
PA1033764220001Medicaid