Healthcare Provider Details

I. General information

NPI: 1932794450
Provider Name (Legal Business Name): DIANA CHERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2021
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1037 W US HIGHWAY 90 STE 150
LAKE CITY FL
32055-3753
US

IV. Provider business mailing address

1409 SW HALTIWANGER RD
LAKE CITY FL
32024-5471
US

V. Phone/Fax

Practice location:
  • Phone: 386-204-4125
  • Fax:
Mailing address:
  • Phone: 386-204-4125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: