1700772522 NPI number — DEVON CHUBB PELTO LCSWA, LCASA

Table of content: DEVON CHUBB PELTO LCSWA, LCASA (NPI 1700772522)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700772522 NPI number — DEVON CHUBB PELTO LCSWA, LCASA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PELTO
Provider First Name:
DEVON
Provider Middle Name:
CHUBB
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSWA, LCASA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHUBB
Provider Other First Name:
DEVON
Provider Other Middle Name:
ELAYNE
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:
1700772522
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/17/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2514 SHENANDOAH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DURHAM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27704-4260
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-302-1168
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1800 W LAKEWOOD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DURHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27707-1133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-335-3447
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/17/2025

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:  P022168 , 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)





Copyright © 2007-2025 www.npivalidator.com