Provider Demographics
NPI:1063753374
Name:CHERRY, KATHLEEN AMANDA (LCMHC)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:AMANDA
Last Name:CHERRY
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7401 CARMEL EXECUTIVE PARK DR STE 210
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-0406
Mailing Address - Country:US
Mailing Address - Phone:704-752-8414
Mailing Address - Fax:704-544-1109
Practice Address - Street 1:7401 CARMEL EXECUTIVE PARK DR STE 210
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-0406
Practice Address - Country:US
Practice Address - Phone:704-752-8414
Practice Address - Fax:704-544-1109
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-12
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9612101Y00000X
101YA0400X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)