Provider Demographics
NPI:1649623869
Name:CHELLEY, DEINYELL (LCAS-A)
Entity type:Individual
Prefix:
First Name:DEINYELL
Middle Name:
Last Name:CHELLEY
Suffix:
Gender:F
Credentials:LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2536 MCKINNEY ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27217-3184
Mailing Address - Country:US
Mailing Address - Phone:336-417-9746
Mailing Address - Fax:
Practice Address - Street 1:3580 NC HIGHWAY 14
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-8746
Practice Address - Country:US
Practice Address - Phone:336-522-5095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-22
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-21214172V00000X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No172V00000XOther Service ProvidersCommunity Health Worker