Provider Demographics
NPI:1588430938
Name:PETEWAY, CHARDENA JOE'NEKE
Entity type:Individual
Prefix:MISS
First Name:CHARDENA
Middle Name:JOE'NEKE
Last Name:PETEWAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1
Mailing Address - Street 2:
Mailing Address - City:CONETOE
Mailing Address - State:NC
Mailing Address - Zip Code:27819-0001
Mailing Address - Country:US
Mailing Address - Phone:252-343-9793
Mailing Address - Fax:
Practice Address - Street 1:204 W THIGPEN RD
Practice Address - Street 2:
Practice Address - City:CONETOE
Practice Address - State:NC
Practice Address - Zip Code:27819
Practice Address - Country:US
Practice Address - Phone:252-343-9793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-28
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician