Provider Demographics
NPI:1821531443
Name:HOSHOR, CHERYL R (LSW, LCDC-III)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:R
Last Name:HOSHOR
Suffix:
Gender:F
Credentials:LSW, LCDC-III
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:R
Other - Last Name:HOSHOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LSW, LCDC-III
Mailing Address - Street 1:12219 BASIL RD NW
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:OH
Mailing Address - Zip Code:43105-9469
Mailing Address - Country:US
Mailing Address - Phone:740-438-2643
Mailing Address - Fax:
Practice Address - Street 1:62 E STEVENS ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-5969
Practice Address - Country:US
Practice Address - Phone:740-366-7303
Practice Address - Fax:740-366-7305
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH141274101YA0400X
OHS 1600672104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)