Provider Demographics
NPI:1477044337
Name:CHIDI, JOY EGO (LCASA)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:EGO
Last Name:CHIDI
Suffix:
Gender:F
Credentials:LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7424 BRIGHTON VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-8633
Mailing Address - Country:US
Mailing Address - Phone:314-283-2476
Mailing Address - Fax:
Practice Address - Street 1:2321 CRABTREE BLVD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-3048
Practice Address - Country:US
Practice Address - Phone:919-848-9108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-25
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24462101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)