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General NPI Number Information
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NPI Number | 1538944285
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Entity Type | Individual
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Provider Name | KAREN ELIZABETH CHACKO
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Gender | Female
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Dates
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Enumeration Date | 08/30/2023
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Last Update Date | 08/30/2023
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Provider Practice Location Address
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Address Line | 765 HIGHLAND OAKS DR STE 100
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City | WINSTON SALEM
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State | NC
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Zip | 27103-7100
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Country | US
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Telephone | 336-926-0429
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Fax |
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Provider Business Mailing Address
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Address Line | 3510 HAYDEN DR
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City | CHARLOTTE
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State | NC
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Zip | 28269-1239
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Country | US
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Telephone | 704-222-9563
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number |
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License Number State |
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