Provider Demographics
NPI:1881791994
Name:BOOTH-MAYES, CHERL JAYE (LPC)
Entity type:Individual
Prefix:
First Name:CHERL
Middle Name:JAYE
Last Name:BOOTH-MAYES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:CHERL
Other - Middle Name:JAYE
Other - Last Name:BOOTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:403 E CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17702-7425
Mailing Address - Country:US
Mailing Address - Phone:570-279-8351
Mailing Address - Fax:570-322-8026
Practice Address - Street 1:435 W 4TH ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-6001
Practice Address - Country:US
Practice Address - Phone:570-322-7873
Practice Address - Fax:570-322-8026
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC003642104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker