Provider Demographics
NPI:1891047759
Name:CHERRY, PAUL M (MA LMFT)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:M
Last Name:CHERRY
Suffix:
Gender:M
Credentials:MA LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11503 SIR FRANCIS DRAKE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-5803
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11503 SIR FRANCIS DRAKE DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-5803
Practice Address - Country:US
Practice Address - Phone:704-560-8706
Practice Address - Fax:919-746-7490
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-02
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1585106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC160HOOOOOXOtherINSURANCE