MEDICARE: CHASTIN LAMONT HARRIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	RBT-25-471013	NC

General Provider Information

NPI Number	:	1770421695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHASTIN LAMONT HARRIS

Provider Business Mailing Address
First Line	:	1101 NORRIS AVE
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28206-2146
Country	:	US
Telephone Number	:	980-307-3102
Fax Number	:

Provider Business Practice Location Address
First Line	:	1101 NORRIS AVE
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28206-2146
Country	:	US
Telephone Number	:	980-307-3102
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2026
Last Update Date	:	03/23/2026

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Directions to “ CHASTIN LAMONT HARRIS ” Practice Location

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