Provider Demographics
NPI:1265158604
Name:CHEVRETTE, CARLY JAINE (BS ADC-IP)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:JAINE
Last Name:CHEVRETTE
Suffix:
Gender:F
Credentials:BS ADC-IP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:557 ABIGAIL ST
Mailing Address - Street 2:
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-6870
Mailing Address - Country:US
Mailing Address - Phone:248-763-5653
Mailing Address - Fax:
Practice Address - Street 1:2470 MALL DR UNIT CD
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-6514
Practice Address - Country:US
Practice Address - Phone:843-207-4721
Practice Address - Fax:847-207-4727
Is Sole Proprietor?:No
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)