Provider Demographics
NPI:1780972679
Name:HERBERT, CHEVON (LPC)
Entity type:Individual
Prefix:
First Name:CHEVON
Middle Name:
Last Name:HERBERT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:CHEVON
Other - Middle Name:
Other - Last Name:CRUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:127 KING ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29401-2279
Mailing Address - Country:US
Mailing Address - Phone:843-408-1192
Mailing Address - Fax:
Practice Address - Street 1:127 KING ST
Practice Address - Street 2:SUITE 202
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29401-2279
Practice Address - Country:US
Practice Address - Phone:843-408-1192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-13
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5614101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional