Provider Demographics
NPI:1679163448
Name:CHAVIS, WALTINA (MS, LCDC)
Entity Type:Individual
Prefix:
First Name:WALTINA
Middle Name:
Last Name:CHAVIS
Suffix:
Gender:F
Credentials:MS, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 152315
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-8315
Mailing Address - Country:US
Mailing Address - Phone:817-893-0994
Mailing Address - Fax:
Practice Address - Street 1:1011 GIBBINS RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-5615
Practice Address - Country:US
Practice Address - Phone:817-893-0994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-25
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16965101YA0400X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)