1437391398 NPI number — CHERYL L. FORDHAM M.S., LPC, NBCCH

Table of content: CHERYL L. FORDHAM M.S., LPC, NBCCH (NPI 1437391398)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437391398 NPI number — CHERYL L. FORDHAM M.S., LPC, NBCCH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FORDHAM
Provider First Name:
CHERYL
Provider Middle Name:
L.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S., LPC, NBCCH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437391398
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/24/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3482 KEITH BRIDGE RD
Provider Second Line Business Mailing Address:
SUITE 316
Provider Business Mailing Address City Name:
CUMMING
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30041-5546
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-547-0235
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
634 PEACHTREE PKWY
Provider Second Line Business Practice Location Address:
SUITE 250
Provider Business Practice Location Address City Name:
CUMMING
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30041-9782
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-547-0235
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/24/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  001953 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)