Provider Demographics
NPI:1578060703
Name:BYRD, CHARNELE DEVONE
Entity Type:Individual
Prefix:
First Name:CHARNELE
Middle Name:DEVONE
Last Name:BYRD
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 1:5639 HORNADAY RD UNIT G
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27409-2976
Mailing Address - Country:US
Mailing Address - Phone:910-551-8283
Mailing Address - Fax:
Practice Address - Street 1:4401 PROVIDENCE LN STE 121
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3226
Practice Address - Country:US
Practice Address - Phone:336-896-1323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-13
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0121391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical