Provider Demographics
NPI:1154118313
Name:CHASE, AVERY
Entity type:Individual
Prefix:
First Name:AVERY
Middle Name:
Last Name:CHASE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6805 COONIE CT
Mailing Address - Street 2:
Mailing Address - City:WILLOW SPRING
Mailing Address - State:NC
Mailing Address - Zip Code:27592-7870
Mailing Address - Country:US
Mailing Address - Phone:919-559-7702
Mailing Address - Fax:
Practice Address - Street 1:6805 COONIE CT
Practice Address - Street 2:
Practice Address - City:WILLOW SPRING
Practice Address - State:NC
Practice Address - Zip Code:27592-7870
Practice Address - Country:US
Practice Address - Phone:919-559-7702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician