Provider Demographics
NPI:1104242171
Name:CHERRYBON, ALICIA MICHELLE (LCSW)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:MICHELLE
Last Name:CHERRYBON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 CROSS CREEK CIR
Mailing Address - Street 2:SUITE A
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-8062
Mailing Address - Country:US
Mailing Address - Phone:850-877-4228
Mailing Address - Fax:888-700-6760
Practice Address - Street 1:1310 CROSS CREEK CIR
Practice Address - Street 2:SUITE A
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-8062
Practice Address - Country:US
Practice Address - Phone:850-877-4228
Practice Address - Fax:888-700-6760
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-13
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW133571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical