Healthcare Provider Details

I. General information

NPI: 1285685404
Provider Name (Legal Business Name): BETTY LOU CHAIKA LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 JONES FERRY RD SUITE F
CARRBORO NC
27510-2036
US

IV. Provider business mailing address

104 JONES FERRY RD SUITE F
CARRBORO NC
27510-2036
US

V. Phone/Fax

Practice location:
  • Phone: 919-549-6690
  • Fax:
Mailing address:
  • Phone: 919-549-6690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2737
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: