Provider Demographics
NPI:1700330198
Name:WALCOTT, CHERYL
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:WALCOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:ANN
Other - Last Name:WALCOTT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ICDC/ICADC, LSW
Mailing Address - Street 1:9918 PARKGATE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44108-3328
Mailing Address - Country:US
Mailing Address - Phone:216-324-1808
Mailing Address - Fax:216-227-1656
Practice Address - Street 1:9918 PARKGATE AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44108-3328
Practice Address - Country:US
Practice Address - Phone:216-324-1808
Practice Address - Fax:216-227-1656
Is Sole Proprietor?:No
Enumeration Date:2016-08-15
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.09005111041C0700X
OH091010101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical