Provider Demographics
NPI:1174341119
Name:SANDERS-HARALSON, CHERISSE C (CDCA)
Entity type:Individual
Prefix:
First Name:CHERISSE
Middle Name:C
Last Name:SANDERS-HARALSON
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26761 HUCKLEBERRY DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44143-1045
Mailing Address - Country:US
Mailing Address - Phone:216-482-6115
Mailing Address - Fax:
Practice Address - Street 1:26761 HUCKLEBERRY DR
Practice Address - Street 2:
Practice Address - City:RICHMOND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44143-1045
Practice Address - Country:US
Practice Address - Phone:216-482-6115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.189940101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)