Organization
CHERRY STREET SERVICES INC
Active
Organization
CHERRY STREET SERVICES INC
Active
Parent organization
CHERRY STREET SERVICES INC
Other names
Southside Health Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
CHERRY STREET SERVICES INC
Authorized official
TASHA BLACKMON (CEO)
(616) 965-8215
Entity
Organization
Contact information
Practice address
2303 KALAMAZOO AVE SE, GRAND RAPIDS, MI 49507-3780
(616) 965-8390
(616) 254-8192
Mailing address
100 CHERRY ST SE, GRAND RAPIDS, MI 49503-4526
(616) 965-8200
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
103TA0400X
Addiction (Substance Use Disorder) Psychologist
—
—
103TC0700X
Clinical Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
163W00000X
Registered Nurse
—
—
207LA0401X
Addiction Medicine (Anesthesiology) Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
09/20/2011
Last updated
08/25/2023
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