Healthcare Provider Details

I. General information

NPI: 1194654491
Provider Name (Legal Business Name): CHERINGTON LACKLAND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 9494
COLUMBUS GA
31908-9494
US

IV. Provider business mailing address

PO BOX 9494
COLUMBUS GA
31908-9494
US

V. Phone/Fax

Practice location:
  • Phone: 804-829-3093
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC010533
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: