Provider Demographics
NPI:1700643350
Name:BENWELL-HEARTY, CHERRISSE CATHERINE (LMSW)
Entity type:Individual
Prefix:
First Name:CHERRISSE
Middle Name:CATHERINE
Last Name:BENWELL-HEARTY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:CHERRISSE
Other - Middle Name:C
Other - Last Name:BENWELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:2517 GOLDEN SHORE DR
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-1059
Mailing Address - Country:US
Mailing Address - Phone:810-618-7173
Mailing Address - Fax:
Practice Address - Street 1:2517 GOLDEN SHORE DR
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-1059
Practice Address - Country:US
Practice Address - Phone:810-618-7173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010713651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical