Doctor Name: | TANISHA CHANTI TRAVIS |
NPI Number: | 1043597982 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 284 Executive Park Drive Suite 100 Concord, NC - 280251894 |
Business Phone Number: | 7049391100 |
Business Fax Number: | 7049391173 |
Mailing Address: | 725 Highland Ave, WINSTON SALEM |
State: | NC |
Postal Code: | 271014206 |
Phone Number: | 3366078523 |
Fax Number: | |
NPI Enumeration Date: | 11/07/2011 |
NPI Last Update Date: | 11/07/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |