Provider Demographics
NPI:1366194771
Name:LALLY, CHERI (LCSW-C)
Entity type:Individual
Prefix:
First Name:CHERI
Middle Name:
Last Name:LALLY
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1239 PINEY HILL RD
Mailing Address - Street 2:
Mailing Address - City:MONKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21111-1405
Mailing Address - Country:US
Mailing Address - Phone:443-865-3359
Mailing Address - Fax:
Practice Address - Street 1:10635 YORK RD FL 2
Practice Address - Street 2:
Practice Address - City:COCKEYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21030-2357
Practice Address - Country:US
Practice Address - Phone:410-397-5881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-26
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13470101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor