Provider Demographics
NPI:1992134456
Name:CHEVERALLS, JAMIE L (MA, NCC, LCMHC)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:L
Last Name:CHEVERALLS
Suffix:
Gender:F
Credentials:MA, NCC, LCMHC
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:L
Other - Last Name:CHACHERE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:706 NORTHEAST DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-7419
Mailing Address - Country:US
Mailing Address - Phone:617-875-2982
Mailing Address - Fax:704-909-4070
Practice Address - Street 1:706 NORTHEAST DR
Practice Address - Street 2:STE 1
Practice Address - City:DAVIDSON
Practice Address - State:NC
Practice Address - Zip Code:28036-7419
Practice Address - Country:US
Practice Address - Phone:617-875-2982
Practice Address - Fax:704-909-4070
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-05
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10813101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health