Provider Demographics
NPI:1376362624
Name:ROSAS, CHYENNE EVA JULIA (LCASA)
Entity type:Individual
Prefix:
First Name:CHYENNE
Middle Name:EVA JULIA
Last Name:ROSAS
Suffix:
Gender:F
Credentials:LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 TARHEEL DR
Mailing Address - Street 2:
Mailing Address - City:HAVELOCK
Mailing Address - State:NC
Mailing Address - Zip Code:28532-1767
Mailing Address - Country:US
Mailing Address - Phone:252-422-1218
Mailing Address - Fax:
Practice Address - Street 1:309 COMMERCE AVE
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-3283
Practice Address - Country:US
Practice Address - Phone:252-773-0306
Practice Address - Fax:252-773-0904
Is Sole Proprietor?:No
Enumeration Date:2024-10-04
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-30244101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)