Provider Demographics
NPI:1518357953
Name:CHAVIS-LEGERTON, AMANDA (MAED, LPC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:CHAVIS-LEGERTON
Suffix:
Gender:F
Credentials:MAED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 SAINT JOSEPH ST APT 16
Mailing Address - Street 2:
Mailing Address - City:CAROLINA BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28428-4700
Mailing Address - Country:US
Mailing Address - Phone:910-736-2925
Mailing Address - Fax:
Practice Address - Street 1:110 BRANCHWOOD DR STE B
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-5900
Practice Address - Country:US
Practice Address - Phone:910-938-9833
Practice Address - Fax:910-938-9835
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-23
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10388101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional