MEDICARE: MS. CAROL JEAN CHERICH LPC-LADAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	0701011189	VA
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	3996	TN

General Provider Information

NPI Number	:	1124026596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAROL JEAN CHERICH LPC-LADAC

Provider Business Mailing Address
First Line	:	7009 HEARTHSIDE DR
Second Line	:
City	:	PRINCE GEORGE
State	:	VA
Zip	:	23875-2664
Country	:	US
Telephone Number	:	301-956-3185
Fax Number	:

Provider Business Practice Location Address
First Line	:	7009 HEARTHSIDE DR
Second Line	:
City	:	PRINCE GEORGE
State	:	VA
Zip	:	23875-2664
Country	:	US
Telephone Number	:	301-956-3185
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2005
Last Update Date	:	04/06/2026

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