Individual
CHAITANYA VENEGALLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
725 HIGHLAND AVE, WINSTON SALEM, NC 27101-4180
(336) 607-8523
(336) 607-8647
Mailing address
284 EXECUTIVE PARK DR STE 100, CONCORD, NC 28025-1833
(704) 939-1100
(704) 939-1173
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
3732
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16583
BCBS
NC
05
—
1700045085
—
NC
01
—
601128-174
MAGELLAN
NC
Enumeration date
06/03/2008
Last updated
07/21/2022
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