Healthcare Provider Details

I. General information

NPI: 1841658416
Provider Name (Legal Business Name): CHERE WYLAND-NORCROSS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2016
Last Update Date: 02/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 WATER STREET
MEADVILLE PA
16335
US

IV. Provider business mailing address

920 WATER STREET
MEADVILLE PA
16335
US

V. Phone/Fax

Practice location:
  • Phone: 814-333-2779
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC008468
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: