Provider Demographics
NPI:1023847985
Name:CHERYL DAVIDSON LCPC PLLC
Entity type:Organization
Organization Name:CHERYL DAVIDSON LCPC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / THERAPIST OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:847-450-8139
Mailing Address - Street 1:311 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-1850
Mailing Address - Country:US
Mailing Address - Phone:847-450-8139
Mailing Address - Fax:630-358-6935
Practice Address - Street 1:311 N 2ND ST
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-1850
Practice Address - Country:US
Practice Address - Phone:847-450-8139
Practice Address - Fax:630-358-6935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health