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General NPI Number Information
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NPI Number | 1184250854
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Entity Type | Individual
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Provider Name | CHERYLL SUE GAVER CACII
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Gender | Female
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Dates
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Enumeration Date | 03/13/2020
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Last Update Date | 03/13/2020
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Provider Practice Location Address
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Address Line | 5833 STEWART PKWY STE 103
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-6933
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Country | US
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Telephone | 844-782-2454
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Fax | 470-532-1732
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Provider Business Mailing Address
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Address Line | 5833 STEWART PKWY STE 103
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-6933
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Country | US
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Telephone | 470-532-1722
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Fax | 470-532-1732
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 3106
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License Number State | GA
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