MEDICARE: MRS. CHERI NICOLE CROMER LPC

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	LPC008411	GA

General Provider Information

NPI Number	:	1235504085
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHERI NICOLE CROMER LPC

Provider Business Mailing Address
First Line	:	1815 E CLAY ST
Second Line	:
City	:	THOMASVILLE
State	:	GA
Zip	:	31792-4736
Country	:	US
Telephone Number	:	229-226-4634
Fax Number	:

Provider Business Practice Location Address
First Line	:	1358 STONE AVE
Second Line	:
City	:	CAIRO
State	:	GA
Zip	:	39828-3566
Country	:	US
Telephone Number	:	229-327-7062
Fax Number	:

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

Provider Enumeration Date	:	12/04/2015
Last Update Date	:	12/04/2015

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