Provider Demographics
NPI:1659097160
Name:CHAVEZ, NATHALLIE LYNNETTE (LCSWA)
Entity Type:Individual
Prefix:
First Name:NATHALLIE
Middle Name:LYNNETTE
Last Name:CHAVEZ
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 1:300 MOORESVILLE RD
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28081-0304
Mailing Address - Country:US
Mailing Address - Phone:704-920-1310
Mailing Address - Fax:704-934-4270
Practice Address - Street 1:363 CHURCH ST N STE 240
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-4525
Practice Address - Country:US
Practice Address - Phone:704-920-1199
Practice Address - Fax:704-445-7508
Is Sole Proprietor?:No
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0181321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical