Provider Demographics
NPI:1982249298
Name:CHAVIS, CORDELIA JOHNSON (LCSW)
Entity Type:Individual
Prefix:
First Name:CORDELIA
Middle Name:JOHNSON
Last Name:CHAVIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7250 SANDCASTLE LN
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28356-9437
Mailing Address - Country:US
Mailing Address - Phone:833-846-3463
Mailing Address - Fax:855-510-6746
Practice Address - Street 1:220 WINTERGREEN DR STE F
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2188
Practice Address - Country:US
Practice Address - Phone:910-536-0581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-11
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0162031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical