Provider Demographics
NPI:1336162213
Name:WEAVER, CHERRY LOUISE
Entity Type:Individual
Prefix:MS
First Name:CHERRY
Middle Name:LOUISE
Last Name:WEAVER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CHERRY
Other - Middle Name:LOUISE
Other - Last Name:SHAFFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:7706 WATER FOWL TRL
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76002-4571
Mailing Address - Country:US
Mailing Address - Phone:817-247-0880
Mailing Address - Fax:817-626-6400
Practice Address - Street 1:111 NW 24TH ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76164-8544
Practice Address - Country:US
Practice Address - Phone:817-626-7640
Practice Address - Fax:817-626-6400
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1660101YA0400X
TX18833101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)