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General NPI Number Information
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NPI Number | 1790072890
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Entity Type | Organization
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Legal Business Name | CHERYL G ANTHONY
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Dates
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Enumeration Date | 07/09/2011
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Last Update Date | 07/09/2011
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Provider Practice Location Address
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Address Line | 2889 SYDNEY ST
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City | JACKSONVILLE
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State | FL
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Zip | 32205-8040
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Country | US
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Telephone | 904-651-5589
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Fax | 904-461-8368
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Provider Business Mailing Address
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Address Line | 2889 SYDNEY ST
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City | JACKSONVILLE
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State | FL
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Zip | 32205-8040
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Country | US
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Telephone | 904-651-5589
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Fax | 904-461-8368
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | CHERYL G ANTHONY
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Credential | LMHC
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Telephone | 904-651-5589
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH9694
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License Number State | FL
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