Provider Demographics
NPI:1053724724
Name:MCKENZIE, CHERYL (PHD,LADC)
Entity type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:PHD,LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 PARK ST
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4710
Mailing Address - Country:US
Mailing Address - Phone:802-775-2395
Mailing Address - Fax:802-773-9656
Practice Address - Street 1:88 PARK ST
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4710
Practice Address - Country:US
Practice Address - Phone:802-775-2395
Practice Address - Fax:802-773-9656
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-10
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT104338101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)