Provider Demographics
NPI:1538944285
Name:CHACKO, KAREN ELIZABETH
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:ELIZABETH
Last Name:CHACKO
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 1:3510 HAYDEN DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-1239
Mailing Address - Country:US
Mailing Address - Phone:704-222-9563
Mailing Address - Fax:
Practice Address - Street 1:765 HIGHLAND OAKS DR STE 100
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-7100
Practice Address - Country:US
Practice Address - Phone:336-926-0429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral