Provider Demographics
NPI:1083430177
Name:LAMB, CHERYL ELAINE (AMFT)
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:ELAINE
Last Name:LAMB
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 528
Mailing Address - Street 2:
Mailing Address - City:ELLABELL
Mailing Address - State:GA
Mailing Address - Zip Code:31308-0528
Mailing Address - Country:US
Mailing Address - Phone:912-667-6474
Mailing Address - Fax:912-442-3147
Practice Address - Street 1:248 BUTLER ST
Practice Address - Street 2:
Practice Address - City:MIDWAY
Practice Address - State:GA
Practice Address - Zip Code:31320-4596
Practice Address - Country:US
Practice Address - Phone:912-667-6474
Practice Address - Fax:912-442-3147
Is Sole Proprietor?:No
Enumeration Date:2024-11-23
Last Update Date:2024-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAMFT000758106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist