Provider Demographics
NPI:1487111530
Name:CHERRY, LARENA (LPC)
Entity type:Individual
Prefix:
First Name:LARENA
Middle Name:
Last Name:CHERRY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9180 STONE RD
Mailing Address - Street 2:
Mailing Address - City:CLAY
Mailing Address - State:MI
Mailing Address - Zip Code:48001-4431
Mailing Address - Country:US
Mailing Address - Phone:586-215-7770
Mailing Address - Fax:
Practice Address - Street 1:359 S WATER ST
Practice Address - Street 2:
Practice Address - City:MARINE CITY
Practice Address - State:MI
Practice Address - Zip Code:48039-1694
Practice Address - Country:US
Practice Address - Phone:586-244-8417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-25
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401222495101YP2500X, 101YP2500X
MI6401016291101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional