Provider Demographics
NPI:1063071652
Name:STOVALL, CHERAE NIKIA
Entity type:Individual
Prefix:
First Name:CHERAE
Middle Name:NIKIA
Last Name:STOVALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:838 PINE AVE UNIT 115
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-5821
Mailing Address - Country:US
Mailing Address - Phone:404-281-9793
Mailing Address - Fax:
Practice Address - Street 1:1704 MANCHESTER BOULEVARD
Practice Address - Street 2:SUITE 202
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90047
Practice Address - Country:US
Practice Address - Phone:323-531-0565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-07
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALPCC15670101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional