=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780960591
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHERI ANDERSON M.ED., LPC, RPT, NCC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2011
-----------------------------------------------------
Last Update Date | 11/29/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 326 MYRTLE CROSSING DR STE 100
-----------------------------------------------------
City | STATESBORO
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30458-4689
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 912-531-0669
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3485 KENNEDY BRIDGE RD
-----------------------------------------------------
City | REGISTER
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30452-3911
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 912-531-0669
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | LPC006540
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------