Provider Demographics
NPI:1386106664
Name:CROFT, CHASTITY DONIELLE (CNA)
Entity type:Individual
Prefix:
First Name:CHASTITY
Middle Name:DONIELLE
Last Name:CROFT
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 E WASHINGTON AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TN
Mailing Address - Zip Code:37303-3668
Mailing Address - Country:US
Mailing Address - Phone:423-453-2200
Mailing Address - Fax:423-453-2223
Practice Address - Street 1:130 E WASHINGTON AVE STE 4
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-3668
Practice Address - Country:US
Practice Address - Phone:423-453-2200
Practice Address - Fax:423-453-2223
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-04
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1000000022719253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1000000022719OtherTENNESSEE DEPARTMENT OF MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES