Healthcare Provider Details

I. General information

NPI: 1578009312
Provider Name (Legal Business Name): DEVON CHARTIER LPCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LIZA CHARTIER LPCA

II. Dates (important events)

Enumeration Date: 01/18/2017
Last Update Date: 01/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5613 DURALEIGH RD SUITE 101
RALEIGH NC
27612-2694
US

IV. Provider business mailing address

5613 DURALEIGH RD SUITE 101
RALEIGH NC
27612-2694
US

V. Phone/Fax

Practice location:
  • Phone: 919-782-4597
  • Fax: 919-784-0089
Mailing address:
  • Phone: 919-782-4597
  • Fax: 919-784-0089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA12433
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: