Individual
DEDRA CHAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3024 WHITE RAIL DR, FUQUAY VARINA, NC 27526-3695
(970) 400-1829
Mailing address
3024 WHITE RAIL DR, FUQUAY VARINA, NC 27526-3695
(970) 400-1829
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0015151
CO
101YM0800X
Mental Health Counselor
21574
NC
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
611458290
—
CO
Enumeration date
03/29/2018
Last updated
03/10/2026
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