Healthcare Provider Details

I. General information

NPI: 1972903045
Provider Name (Legal Business Name): CHERYL CONNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2014
Last Update Date: 08/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 GRESHAM RD
GRESHAM SC
29546-5173
US

IV. Provider business mailing address

223 GRESHAM RD
GRESHAM SC
29546-5173
US

V. Phone/Fax

Practice location:
  • Phone: 843-362-3510
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: