Provider Demographics
NPI:1205436730
Name:CHILES, JOY ELISE (MS,MHQP, LCAS)
Entity type:Individual
Prefix:MRS
First Name:JOY
Middle Name:ELISE
Last Name:CHILES
Suffix:
Gender:F
Credentials:MS,MHQP, LCAS
Other - Prefix:MRS
Other - First Name:JOY
Other - Middle Name:
Other - Last Name:CHILES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCAS
Mailing Address - Street 1:8505 MOUNT VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-6931
Mailing Address - Country:US
Mailing Address - Phone:919-928-3036
Mailing Address - Fax:
Practice Address - Street 1:8505 MOUNT VALLEY LN
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-6931
Practice Address - Country:US
Practice Address - Phone:919-928-3036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22099101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)