Healthcare Provider Details

I. General information

NPI: 1952625246
Provider Name (Legal Business Name): CHERISA STANDRIDGE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHERISA DEBOLT LCSW

II. Dates (important events)

Enumeration Date: 03/16/2010
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 33100 BOX LRMC
APO RHINELAND PFALZ
09034
DE

IV. Provider business mailing address

UNIT 33100 BOX LRMC US ARMY HEALTH CLINIC BAUMHOLDER
APO AE
09034
DE

V. Phone/Fax

Practice location:
  • Phone: 314-590-1032
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4353
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: