Provider Demographics
NPI:1295753572
Name:BIGELOW, CHERYL DODGE (MA, LPC)
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:DODGE
Last Name:BIGELOW
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 OAKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:MI
Mailing Address - Zip Code:48433-1849
Mailing Address - Country:US
Mailing Address - Phone:810-659-4632
Mailing Address - Fax:
Practice Address - Street 1:422 OAKWOOD DR
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:MI
Practice Address - Zip Code:48433-1849
Practice Address - Country:US
Practice Address - Phone:810-659-4632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401001489101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional