Provider Demographics
NPI:1023573508
Name:LIVINGSTON, CHAQUEENIA YVETTE (MA, NCC, LCMHC)
Entity Type:Individual
Prefix:
First Name:CHAQUEENIA
Middle Name:YVETTE
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:MA, NCC, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:276 OLD MOCKSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28625-1949
Mailing Address - Country:US
Mailing Address - Phone:704-317-2931
Mailing Address - Fax:
Practice Address - Street 1:276 OLD MOCKSVILLE RD
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28625-1949
Practice Address - Country:US
Practice Address - Phone:704-317-2931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-08
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14595101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty