Provider Demographics
NPI:1548477524
Name:ANTHONY, CHERYL G (LMHC)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:G
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2889 SYDNEY STREET
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32205-8040
Mailing Address - Country:US
Mailing Address - Phone:904-651-5589
Mailing Address - Fax:
Practice Address - Street 1:1955 US 1 S STE C2
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5786
Practice Address - Country:US
Practice Address - Phone:904-209-6001
Practice Address - Fax:904-209-6002
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9694101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health