Provider Demographics
NPI:1932667268
Name:CHERRY, DONNA MARIE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:MARIE
Last Name:CHERRY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:MARIE
Other - Last Name:BLOXOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1112 PORTERS RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-7198
Mailing Address - Country:US
Mailing Address - Phone:252-341-4971
Mailing Address - Fax:
Practice Address - Street 1:4300 SAPPHIRE CT STE 110
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-9079
Practice Address - Country:US
Practice Address - Phone:252-830-7540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-05
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0099891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical