Provider Demographics
NPI:1316763998
Name:CHAVIS, JAMACA NICOLE (LPC)
Entity type:Individual
Prefix:
First Name:JAMACA
Middle Name:NICOLE
Last Name:CHAVIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 BRADDOCK AVE
Mailing Address - Street 2:
Mailing Address - City:BRADDOCK
Mailing Address - State:PA
Mailing Address - Zip Code:15104-1849
Mailing Address - Country:US
Mailing Address - Phone:412-584-3040
Mailing Address - Fax:412-824-0948
Practice Address - Street 1:723 BRADDOCK AVE
Practice Address - Street 2:
Practice Address - City:BRADDOCK
Practice Address - State:PA
Practice Address - Zip Code:15104-1849
Practice Address - Country:US
Practice Address - Phone:412-584-3040
Practice Address - Fax:412-824-0948
Is Sole Proprietor?:No
Enumeration Date:2024-11-27
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA017900101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional