Provider Demographics
NPI:1790893212
Name:BLACKSHEAR, CHERYLL (MS,CAP,SAP,CAPP)
Entity Type:Individual
Prefix:MS
First Name:CHERYLL
Middle Name:
Last Name:BLACKSHEAR
Suffix:
Gender:F
Credentials:MS,CAP,SAP,CAPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10631 N KENDALL DR
Mailing Address - Street 2:SUITE 115
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1568
Mailing Address - Country:US
Mailing Address - Phone:305-274-4330
Mailing Address - Fax:305-274-3822
Practice Address - Street 1:10631 N KENDALL DR
Practice Address - Street 2:SUITE 115
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1568
Practice Address - Country:US
Practice Address - Phone:305-274-4330
Practice Address - Fax:305-274-3822
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YA0400X
101YM0800X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker