1992134456 NPI number — JAMIE L. CHEVERALLS MA, NCC, LCMHC

Table of content: NEGIN RIVKA RAHMANI OTR/L (NPI 1972117778)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992134456 NPI number — JAMIE L. CHEVERALLS MA, NCC, LCMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHEVERALLS
Provider First Name:
JAMIE
Provider Middle Name:
L.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, NCC, LCMHC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHACHERE
Provider Other First Name:
JAMIE
Provider Other Middle Name:
L.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1992134456
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/23/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
706 NORTHEAST DR
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
DAVIDSON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28036-7419
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-875-2982
Provider Business Mailing Address Fax Number:
704-909-4070

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
706 NORTHEAST DR
Provider Second Line Business Practice Location Address:
STE 1
Provider Business Practice Location Address City Name:
DAVIDSON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28036-7419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-875-2982
Provider Business Practice Location Address Fax Number:
704-909-4070
Provider Enumeration Date:
11/05/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  10813 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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