Provider Demographics
NPI:1629814405
Name:BREVIG, CHRISDEE
Entity type:Individual
Prefix:
First Name:CHRISDEE
Middle Name:
Last Name:BREVIG
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 1:505 S ACADEMY ST
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-3203
Mailing Address - Country:US
Mailing Address - Phone:919-922-8225
Mailing Address - Fax:
Practice Address - Street 1:8430 UNIVERSITY EXEC PARK DR STE 665
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-1301
Practice Address - Country:US
Practice Address - Phone:980-237-9731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health