Provider Demographics
NPI:1902064645
Name:SANFILIPPO, CHACY ROSE (MED, NCC, LPC)
Entity Type:Individual
Prefix:
First Name:CHACY
Middle Name:ROSE
Last Name:SANFILIPPO
Suffix:
Gender:F
Credentials:MED, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 MCLEAN AVE
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27127-3817
Mailing Address - Country:US
Mailing Address - Phone:336-650-1335
Mailing Address - Fax:
Practice Address - Street 1:608 MCLEAN AVE
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27127-3817
Practice Address - Country:US
Practice Address - Phone:336-650-1335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional