Individual
TANISHA CHANTI TRAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
284 EXECUTIVE PARK DRIVE, SUITE 100, CONCORD, NC 28025-1894
(704) 939-1100
(704) 939-1173
Mailing address
725 HIGHLAND AVE, WINSTON SALEM, NC 27101-4206
(336) 607-8523
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
11/07/2011
Last updated
11/07/2011
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