Healthcare Provider Details

I. General information

NPI: 1548477524
Provider Name (Legal Business Name): CHERYL G ANTHONY LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 11/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1955 US 1 S STE C2
ST AUGUSTINE FL
32086-5786
US

IV. Provider business mailing address

2889 SYDNEY STREET
JACKSONVILLE FL
32205-8040
US

V. Phone/Fax

Practice location:
  • Phone: 904-209-6001
  • Fax: 904-209-6002
Mailing address:
  • Phone: 904-651-5589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH9694
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: