Provider Demographics
NPI:1457602740
Name:PERRY, TREA LACHELLE (CSAC)
Entity Type:Individual
Prefix:
First Name:TREA
Middle Name:LACHELLE
Last Name:PERRY
Suffix:
Gender:F
Credentials:CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 HENDERSON DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-5602
Mailing Address - Country:US
Mailing Address - Phone:910-938-9550
Mailing Address - Fax:910-938-5912
Practice Address - Street 1:120 HENDERSON DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-5602
Practice Address - Country:US
Practice Address - Phone:910-938-9550
Practice Address - Fax:910-938-5912
Is Sole Proprietor?:No
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)