Provider Demographics
NPI:1891361960
Name:DAVIDSON, CHERYL A (MA, LCPC)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:A
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 N 2ND ST STE 207
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-1852
Mailing Address - Country:US
Mailing Address - Phone:630-797-9192
Mailing Address - Fax:
Practice Address - Street 1:311 N 2ND ST STE 207
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-1852
Practice Address - Country:US
Practice Address - Phone:630-797-9192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-31
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180015470101YP2500X
IL178016078101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional