Provider Information for 1033414743
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CHASITY YVETTE CHAMBLISS Therapist
Sex: Female
NPI: 1033414743
Last Updated: 2024-03-22
Certification Date: 2024-03-22
Certification Date: 2024-03-22
Details
| Name | Value | ||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1033414743 | ||||||||||||||||
| Enumeration Date | 2011-01-12 | ||||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||||
| Sole Proprietor | YES | ||||||||||||||||
| Status | Active | ||||||||||||||||
| Mailing Address | 112 POST OAK RD YORKTOWN, VA 23693-4967 United States Phone: 727-504-7198 | Fax: | ||||||||||||||||
| Primary Practice Address | 100 EMANCIPATION DR HAMPTON, VA 23667-2829 United States Phone: 757-772-9961 | Fax: | ||||||||||||||||
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