Provider Demographics
NPI:1093398323
Name:EDINGTON, CHEVY (MED, BCBA)
Entity Type:Individual
Prefix:
First Name:CHEVY
Middle Name:
Last Name:EDINGTON
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6004 WALDEN DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-6370
Mailing Address - Country:US
Mailing Address - Phone:865-766-5775
Mailing Address - Fax:
Practice Address - Street 1:6004 WALDEN DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-6370
Practice Address - Country:US
Practice Address - Phone:865-766-5775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1-21-49638103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNRBT-20-119824OtherRBT