Provider Demographics
NPI:1568120780
Name:KEATON-CHESSON, TAJANAY SHARRON-MARIE (LCSWA)
Entity Type:Individual
Prefix:
First Name:TAJANAY
Middle Name:SHARRON-MARIE
Last Name:KEATON-CHESSON
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8018 SHERINGHAM WAY
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28227-3100
Mailing Address - Country:US
Mailing Address - Phone:980-423-9379
Mailing Address - Fax:
Practice Address - Street 1:8018 SHERINGHAM WAY
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28227-3100
Practice Address - Country:US
Practice Address - Phone:980-423-9379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-05
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP017002101Y00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor