Provider Demographics
NPI:1184250854
Name:GAVER, CHERYLL SUE (CACII)
Entity type:Individual
Prefix:
First Name:CHERYLL
Middle Name:SUE
Last Name:GAVER
Suffix:
Gender:F
Credentials:CACII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5833 STEWART PKWY STE 103
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-6933
Mailing Address - Country:US
Mailing Address - Phone:470-532-1722
Mailing Address - Fax:470-532-1732
Practice Address - Street 1:5833 STEWART PKWY STE 103
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-6933
Practice Address - Country:US
Practice Address - Phone:844-782-2454
Practice Address - Fax:470-532-1732
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-13
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3106101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)