Healthcare Provider Details

I. General information

NPI: 1518044379
Provider Name (Legal Business Name): CHERI TIMKO M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 05/13/2023
Certification Date: 05/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 E. FAIRMONT ROAD SUITE A
FAIRMONT WV
26554
US

IV. Provider business mailing address

421 LICK RUN RD
FAIRMONT WV
26554-8856
US

V. Phone/Fax

Practice location:
  • Phone: 304-534-8227
  • Fax: 304-534-3535
Mailing address:
  • Phone: 304-534-8227
  • Fax: 304-363-2287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1917
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC1659
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: