Provider Demographics
NPI:1447540125
Name:CHERRY, GAVIN (MS, LCMHC, MLADC)
Entity type:Individual
Prefix:
First Name:GAVIN
Middle Name:
Last Name:CHERRY
Suffix:
Gender:M
Credentials:MS, LCMHC, MLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 CHENELL DR STE 100
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-8514
Mailing Address - Country:US
Mailing Address - Phone:603-545-8355
Mailing Address - Fax:
Practice Address - Street 1:6 CHENELL DR STE 100
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301
Practice Address - Country:US
Practice Address - Phone:603-545-8355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-14
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH853101YA0400X
NH983101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)