Provider Demographics
NPI:1942779392
Name:FOXWORTH, CHERYL NIKKI (MA, LMFT, AS)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:NIKKI
Last Name:FOXWORTH
Suffix:
Gender:F
Credentials:MA, LMFT, AS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7171 N UBER ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19138-2115
Mailing Address - Country:US
Mailing Address - Phone:215-828-0890
Mailing Address - Fax:
Practice Address - Street 1:610 YORK ROAD
Practice Address - Street 2:SUITE 400
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-2837
Practice Address - Country:US
Practice Address - Phone:267-627-3026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-15
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF000810101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health