Provider Demographics
NPI:1568568970
Name:CRAIGHEAD-DAVIS, CHINITA GEREAN (MED, LPC, LCAS, CCS)
Entity Type:Individual
Prefix:MRS
First Name:CHINITA
Middle Name:GEREAN
Last Name:CRAIGHEAD-DAVIS
Suffix:
Gender:F
Credentials:MED, LPC, LCAS, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3205 FREEDOM DR STE 2000
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-3486
Mailing Address - Country:US
Mailing Address - Phone:704-816-0260
Mailing Address - Fax:
Practice Address - Street 1:3205 FREEDOM DR STE 2000
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-3486
Practice Address - Country:US
Practice Address - Phone:704-816-0260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4116101YM0800X
NC1285101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102607Medicaid