Provider Demographics
NPI:1689981466
Name:CHASE, IRA BURTON (LPC)
Entity Type:Individual
Prefix:MR
First Name:IRA
Middle Name:BURTON
Last Name:CHASE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7708 KARYLSTURN CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-0995
Mailing Address - Country:US
Mailing Address - Phone:704-594-9993
Mailing Address - Fax:
Practice Address - Street 1:7708 KARYLSTURN CT
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-0995
Practice Address - Country:US
Practice Address - Phone:704-594-9993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-01
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC772101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional