Provider Demographics
NPI:1124420070
Name:RICHARDSON, CHONTAYE MICHELLE
Entity type:Individual
Prefix:MISS
First Name:CHONTAYE
Middle Name:MICHELLE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16803 SILVERSWORD DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-4883
Mailing Address - Country:US
Mailing Address - Phone:980-833-1198
Mailing Address - Fax:980-833-1198
Practice Address - Street 1:16803 SILVERSWORD DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-4883
Practice Address - Country:US
Practice Address - Phone:980-833-1198
Practice Address - Fax:980-833-1198
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-23
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator