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General NPI Number Information
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NPI Number | 1336162213
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Entity Type | Individual
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Provider Name | MS. CHERRY LOUISE WEAVER
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Gender | Female
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 01/24/2012
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Provider Practice Location Address
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Address Line | 111 NW 24TH ST
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City | FORT WORTH
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State | TX
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Zip | 76164-8544
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Country | US
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Telephone | 817-626-7640
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Fax | 817-626-6400
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Provider Business Mailing Address
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Address Line | 7706 WATER FOWL TRL
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City | ARLINGTON
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State | TX
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Zip | 76002-4571
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Country | US
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Telephone | 817-247-0880
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Fax | 817-626-6400
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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 | 1660
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 18833
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License Number State | TX
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