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NPI Code Detail

MEDICARE: MR. IVEY LEWIS CHAVIS LCSW

MEDICARE: MR. IVEY LEWIS CHAVIS LCSW
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
11041C0700XClinical Social WorkerC 003614NC

General Provider Information

NPI Number : 1780640854
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. IVEY LEWIS CHAVIS LCSW
Provider Business Mailing Address
First Line : 2218 LYNDHURST DR
Second Line :
City : RALEIGH
State : NC
Zip : 27610-4952
Country : US
Telephone Number : 919-831-9929
Fax Number : 919-416-5834
Provider Business Practice Location Address
First Line : 508 FULTON ST
Second Line :
City : DURHAM
State : NC
Zip : 27705-3875
Country : US
Telephone Number : 919-286-0411
Fax Number : 919-416-5834
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/26/2006
Last Update Date : 07/08/2007

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