Provider Demographics
NPI:1144861741
Name:CHAVEZ, BERTA (LCSW)
Entity type:Individual
Prefix:
First Name:BERTA
Middle Name:
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 SILVER HILLS DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-8749
Mailing Address - Country:US
Mailing Address - Phone:910-265-9992
Mailing Address - Fax:
Practice Address - Street 1:200 VALENCIA DR STE 109
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6312
Practice Address - Country:US
Practice Address - Phone:910-330-7559
Practice Address - Fax:910-996-0777
Is Sole Proprietor?:No
Enumeration Date:2019-10-04
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0145581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical