=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730553967
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHANTELLE RENEE HOPKINS LCMHC, LCAS-A
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/27/2015
-----------------------------------------------------
Last Update Date | 02/10/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2443 LYNN RD STE 112
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27612-6759
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-646-1950
-----------------------------------------------------
Fax | 919-800-3245
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3445 TERAVISTA WAY
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27616-9310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-646-1950
-----------------------------------------------------
Fax | 919-800-3245
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | LCAS-25-274
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | A11647
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 11647
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------