Provider Demographics
NPI:1871761171
Name:CHENEVERT, KARRIE ANN (MAPC, LISAC)
Entity type:Individual
Prefix:
First Name:KARRIE
Middle Name:ANN
Last Name:CHENEVERT
Suffix:
Gender:F
Credentials:MAPC, LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7155 W CAMPO BELLO DR
Mailing Address - Street 2:SUITE B160
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-8590
Mailing Address - Country:US
Mailing Address - Phone:623-533-5138
Mailing Address - Fax:
Practice Address - Street 1:7155 W CAMPO BELLO DR
Practice Address - Street 2:SUITE B160
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8590
Practice Address - Country:US
Practice Address - Phone:623-533-5138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-11558101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)