Healthcare Provider Details

I. General information

NPI: 1356633044
Provider Name (Legal Business Name): SHERRI MELINDA CHAVIS LPCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2011
Last Update Date: 05/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18525 STATESVILLE RD SUITE C-01
CORNELIUS NC
28031-5706
US

IV. Provider business mailing address

18525 STATESVILLE RD SUITE C-01
CORNELIUS NC
28031-5706
US

V. Phone/Fax

Practice location:
  • Phone: 704-488-2249
  • Fax:
Mailing address:
  • Phone: 704-488-2249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberA8663
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: