Provider Demographics
NPI:1730962655
Name:GIBBS POPE, CHERISE NICOLE (LSW)
Entity type:Individual
Prefix:
First Name:CHERISE
Middle Name:NICOLE
Last Name:GIBBS POPE
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:CHERISE
Other - Middle Name:NICOLE
Other - Last Name:GIBBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:240 W 11TH ST STE 105
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16501-1758
Mailing Address - Country:US
Mailing Address - Phone:814-453-7955
Mailing Address - Fax:
Practice Address - Street 1:240 W 11TH ST STE 105
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16501-1758
Practice Address - Country:US
Practice Address - Phone:814-453-7955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW135827104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker