Provider Demographics
NPI:1457879744
Name:ELIJAH, CHERRISE L (LCSW)
Entity type:Individual
Prefix:
First Name:CHERRISE
Middle Name:L
Last Name:ELIJAH
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 1:12204 CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-4043
Mailing Address - Country:US
Mailing Address - Phone:310-629-8694
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 1158
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90251-1158
Practice Address - Country:US
Practice Address - Phone:424-262-1983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-06
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW104292104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker