Provider Demographics
NPI:1497268387
Name:CHELLEY, SHABAZZ JAMA
Entity Type:Individual
Prefix:
First Name:SHABAZZ
Middle Name:JAMA
Last Name:CHELLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 ELSWORTH CT
Mailing Address - Street 2:
Mailing Address - City:MC LEANSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27301-9308
Mailing Address - Country:US
Mailing Address - Phone:336-512-3381
Mailing Address - Fax:
Practice Address - Street 1:7 ELSWORTH CT
Practice Address - Street 2:
Practice Address - City:MC LEANSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27301-9308
Practice Address - Country:US
Practice Address - Phone:336-512-3381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-14
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral