Provider Demographics
NPI:1558739292
Name:CHILTON, ANDREA JANELLE
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:JANELLE
Last Name:CHILTON
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 1:100 CAPITOLA DR STE 310
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-4497
Mailing Address - Country:US
Mailing Address - Phone:919-474-6408
Mailing Address - Fax:
Practice Address - Street 1:100 CAPITOLA DR STE 310
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-4497
Practice Address - Country:US
Practice Address - Phone:919-474-6408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-11
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0112051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical