Provider Demographics
NPI:1982726733
Name:CHERRY, LINDA MARIE (LCPC)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:MARIE
Last Name:CHERRY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:EAST PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61611-1167
Mailing Address - Country:US
Mailing Address - Phone:309-698-8441
Mailing Address - Fax:309-690-3339
Practice Address - Street 1:7150 N UNIVERSITY ST
Practice Address - Street 2:SUITE E
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-1752
Practice Address - Country:US
Practice Address - Phone:309-690-3339
Practice Address - Fax:309-690-3339
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180001967101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional