MEDICARE: CHERYL CHILDERS LISW-CP, LPC, ATR-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	9476	SC
2	1041C0700X	Clinical Social Worker	177135	AK
3	1041C0700X	Clinical Social Worker	9476	SC
4	1041C0700X	Clinical Social Worker	C010137	NC

General Provider Information

NPI Number	:	1508110925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERYL CHILDERS LISW-CP, LPC, ATR-BC

Provider Business Mailing Address
First Line	:	1527 WADE HAMPTON BLVD
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29609-5047
Country	:	US
Telephone Number	:	864-501-3633
Fax Number	:	864-448-1766

Provider Business Practice Location Address
First Line	:	1527 WADE HAMPTON BLVD
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29609-5047
Country	:	US
Telephone Number	:	864-501-3633
Fax Number	:	864-448-1766

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2012
Last Update Date	:	05/07/2024

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