Provider Demographics
NPI:1487468070
Name:CHANEY, ANNA VASSILION (MED, LPA, HSP-PA)
Entity type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:VASSILION
Last Name:CHANEY
Suffix:
Gender:F
Credentials:MED, LPA, HSP-PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 GRANITE GROVE LOOP APT 207
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-3777
Mailing Address - Country:US
Mailing Address - Phone:919-389-7474
Mailing Address - Fax:
Practice Address - Street 1:3040 BERKS WAY STE 103
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-6620
Practice Address - Country:US
Practice Address - Phone:919-556-6501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6575103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool