Provider Demographics
NPI:1245733054
Name:CHAVIS, JAMES ANTHONY
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ANTHONY
Last Name:CHAVIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 CAMPLAND CIR
Mailing Address - Street 2:
Mailing Address - City:DONEGAL
Mailing Address - State:PA
Mailing Address - Zip Code:15628-4000
Mailing Address - Country:US
Mailing Address - Phone:412-277-5071
Mailing Address - Fax:
Practice Address - Street 1:10 DUFF RD STE 201
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15235-3209
Practice Address - Country:US
Practice Address - Phone:412-871-5391
Practice Address - Fax:412-430-0259
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-18
Last Update Date:2018-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW010383L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty