Provider Demographics
NPI:1871341628
Name:HENDRICKS, CHANYEL LATISHA (LCSWA)
Entity type:Individual
Prefix:MRS
First Name:CHANYEL
Middle Name:LATISHA
Last Name:HENDRICKS
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:CHANYEL
Other - Middle Name:LATISHA
Other - Last Name:PITTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSW
Mailing Address - Street 1:151 TORREY HEIGHTS LN
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-8956
Mailing Address - Country:US
Mailing Address - Phone:803-381-2333
Mailing Address - Fax:
Practice Address - Street 1:7701 SIX FORKS RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-5050
Practice Address - Country:US
Practice Address - Phone:919-676-4784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0176741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical