MEDICARE: CHERYL JOYCE BOUCHER LPC

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	101YP2500X	Professional Counselor	009993	GA

General Provider Information

NPI Number	:	1588262125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERYL JOYCE BOUCHER LPC

Provider Business Mailing Address
First Line	:	800 BRIGGS ROAD
Second Line	:
City	:	NORTH AUGUSTA
State	:	SC
Zip	:	29860
Country	:	US
Telephone Number	:	706-524-4846
Fax Number	:

Provider Business Practice Location Address
First Line	:	2609 COMMONS BLVD
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30909-6059
Country	:	US
Telephone Number	:	706-843-6241
Fax Number	:

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

Provider Enumeration Date	:	10/15/2020
Last Update Date	:	10/15/2020

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