Provider Demographics
NPI:1790072890
Name:CHERYL G ANTHONY
Entity Type:Organization
Organization Name:CHERYL G ANTHONY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:G
Authorized Official - Last Name:ANTHONY
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:904-651-5589
Mailing Address - Street 1:2889 SYDNEY ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32205-8040
Mailing Address - Country:US
Mailing Address - Phone:904-651-5589
Mailing Address - Fax:904-461-8368
Practice Address - Street 1:2889 SYDNEY ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-8040
Practice Address - Country:US
Practice Address - Phone:904-651-5589
Practice Address - Fax:904-461-8368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-09
Last Update Date:2011-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9694101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty