1124429295 NPI number — MR. DAVEY JAMES CHASTANG BA-PSY, LCSW, PIP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124429295 NPI number — MR. DAVEY JAMES CHASTANG BA-PSY, LCSW, PIP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHASTANG
Provider First Name:
DAVEY
Provider Middle Name:
JAMES
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
BA-PSY, LCSW, PIP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124429295
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/09/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
601 BEL AIR BLVD
Provider Second Line Business Mailing Address:
SUITE 406
Provider Business Mailing Address City Name:
MOBILE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36606-2808
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-581-3365
Provider Business Mailing Address Fax Number:
251-607-6068

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 BEL AIR BLVD
Provider Second Line Business Practice Location Address:
SUITE 406
Provider Business Practice Location Address City Name:
MOBILE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36606-2808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-581-3365
Provider Business Practice Location Address Fax Number:
251-607-6068
Provider Enumeration Date:
09/09/2014

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: 1041C0700X , with the licence number:  1130-3652C , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com