Provider Demographics
NPI:1851555767
Name:WALSH, CHAILLE ANNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHAILLE
Middle Name:ANNE
Last Name:WALSH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-4683
Mailing Address - Country:US
Mailing Address - Phone:919-286-3453
Mailing Address - Fax:919-286-7033
Practice Address - Street 1:2020 W MAIN ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-4683
Practice Address - Country:US
Practice Address - Phone:919-286-3453
Practice Address - Fax:919-286-7033
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3309103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist