Healthcare Provider Details

I. General information

NPI: 1447826847
Provider Name (Legal Business Name): CHERISSE HUNTER-SOUTHERN ED.D.C.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHERISSE SOUTHERN LPCC 20939

II. Dates (important events)

Enumeration Date: 05/27/2021
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3610 CENTRAL AVE STE 400
RIVERSIDE CA
92506-5907
US

IV. Provider business mailing address

3610 CENTRAL AVE STE 400
RIVERSIDE CA
92506-5907
US

V. Phone/Fax

Practice location:
  • Phone: 951-250-8852
  • Fax:
Mailing address:
  • Phone: 951-250-8852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number20939
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number20939
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: