Organization
CHRYSALIS CENTER FOR COUNSELING AND EATING DISORDER TREATMENT PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MACON FUNDERBURK (OFFICE MANAGER)
(910) 790-9500
Entity
Organization
Contact information
Practice address
3240 BURNT MILL DR STE 1, WILMINGTON, NC 28403-2570
(910) 790-9500
(910) 796-8111
Mailing address
3240 BURNT MILL DR STE 101, WILMINGTON, NC 28403-2576
(910) 790-9500
(910) 796-8111
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
2805
NC
103TC1900X
Counseling Psychologist
LPC6828
NC
1041C0700X
Clinical Social Worker
C006434
NC
133V00000X
Registered Dietitian
L003399
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
018AM
BCBS
NC
01
—
355080
MHN/TRICARE
NC
Enumeration date
11/09/2006
Last updated
08/21/2024
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