Provider Demographics
NPI:1184938342
Name:CHILDRESS, EMILY KAREN (EMILY CHILDRESS)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:KAREN
Last Name:CHILDRESS
Suffix:
Gender:F
Credentials:EMILY CHILDRESS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 AVENT PINES LN
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-8618
Mailing Address - Country:US
Mailing Address - Phone:984-363-9195
Mailing Address - Fax:
Practice Address - Street 1:362 RALEIGH ST
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540-9047
Practice Address - Country:US
Practice Address - Phone:984-363-9195
Practice Address - Fax:515-233-6500
Is Sole Proprietor?:No
Enumeration Date:2010-07-29
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000322106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist