Provider Demographics
NPI:1467571265
Name:CHADWELL, GAIL L (CCS)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:L
Last Name:CHADWELL
Suffix:
Gender:F
Credentials:CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5075 RIVES CHAPEL CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:SILER CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27344-7568
Mailing Address - Country:US
Mailing Address - Phone:919-837-0269
Mailing Address - Fax:
Practice Address - Street 1:842 E PRITCHARD ST
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-4800
Practice Address - Country:US
Practice Address - Phone:336-633-7257
Practice Address - Fax:336-625-1154
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC339101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6110548Medicaid