Healthcare Provider Details

I. General information

NPI: 1144862632
Provider Name (Legal Business Name): CHASITY SCOGGINS MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHASITY WESTERHAUSEN

II. Dates (important events)

Enumeration Date: 10/16/2019
Last Update Date: 10/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1804 MARTIN LUTHER KING PKWY STE 112
DURHAM NC
27707-3587
US

IV. Provider business mailing address

16800 BUFFALO RD
WENDELL NC
27591-7314
US

V. Phone/Fax

Practice location:
  • Phone: 919-246-5664
  • Fax: 919-321-0351
Mailing address:
  • Phone: 757-754-0667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: