Provider Demographics
NPI:1588262125
Name:BOUCHER, CHERYL JOYCE (LPC)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:JOYCE
Last Name:BOUCHER
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 1:800 BRIGGS ROAD
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29860
Mailing Address - Country:US
Mailing Address - Phone:706-524-4846
Mailing Address - Fax:
Practice Address - Street 1:2609 COMMONS BLVD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6059
Practice Address - Country:US
Practice Address - Phone:706-843-6241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA009993101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional