Provider Demographics
NPI:1154682490
Name:CHENOWETH, CHRISSA LYNNE
Entity Type:Individual
Prefix:
First Name:CHRISSA
Middle Name:LYNNE
Last Name:CHENOWETH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7125 HITT RD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36695-4431
Mailing Address - Country:US
Mailing Address - Phone:251-422-1827
Mailing Address - Fax:
Practice Address - Street 1:7125 HITT RD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36695-4431
Practice Address - Country:US
Practice Address - Phone:251-422-1827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-04
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician