Provider Demographics
NPI:1902008535
Name:ROYAL, CHADWICK WELDON (PHD, LCMHCS)
Entity Type:Individual
Prefix:DR
First Name:CHADWICK
Middle Name:WELDON
Last Name:ROYAL
Suffix:
Gender:M
Credentials:PHD, LCMHCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 E CENTER ST OFC B-6
Mailing Address - Street 2:
Mailing Address - City:MEBANE
Mailing Address - State:NC
Mailing Address - Zip Code:27302-2420
Mailing Address - Country:US
Mailing Address - Phone:336-684-0697
Mailing Address - Fax:
Practice Address - Street 1:105 E CENTER ST OFC B-6
Practice Address - Street 2:
Practice Address - City:MEBANE
Practice Address - State:NC
Practice Address - Zip Code:27302-2420
Practice Address - Country:US
Practice Address - Phone:336-684-0697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3419S101YM0800X
NC3419101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3419OtherNC COUNSELING LICENSE
NC6102662Medicaid