Provider Demographics
NPI:1306492418
Name:PENICK, CHALIYAH (MAC, LAC)
Entity type:Individual
Prefix:MRS
First Name:CHALIYAH
Middle Name:
Last Name:PENICK
Suffix:
Gender:F
Credentials:MAC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 ERIAL RD
Mailing Address - Street 2:
Mailing Address - City:PINE HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08021-6301
Mailing Address - Country:US
Mailing Address - Phone:856-534-6282
Mailing Address - Fax:856-627-4556
Practice Address - Street 1:521 ERIAL RD
Practice Address - Street 2:
Practice Address - City:PINE HILL
Practice Address - State:NJ
Practice Address - Zip Code:08021-6301
Practice Address - Country:US
Practice Address - Phone:856-534-6282
Practice Address - Fax:856-627-4556
Is Sole Proprietor?:No
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist