Provider Demographics
NPI:1184339061
Name:MACIAS, CHERYL A
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:A
Last Name:MACIAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 HAZZARD CREEK VLG UNIT C
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:SC
Mailing Address - Zip Code:29936-8266
Mailing Address - Country:US
Mailing Address - Phone:843-645-7700
Mailing Address - Fax:
Practice Address - Street 1:77 HAZZARD CREEK VLG UNIT C
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:SC
Practice Address - Zip Code:29936-8266
Practice Address - Country:US
Practice Address - Phone:843-645-7700
Practice Address - Fax:888-908-7339
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty