Provider Demographics
NPI:1053613208
Name:CHANAS, TAMSON ANNE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:TAMSON
Middle Name:ANNE
Last Name:CHANAS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5007 LAWNDALE DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-1866
Mailing Address - Country:US
Mailing Address - Phone:862-266-1364
Mailing Address - Fax:336-265-8297
Practice Address - Street 1:2307 W CONE BLVD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-4027
Practice Address - Country:US
Practice Address - Phone:862-266-1364
Practice Address - Fax:336-265-8297
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-20
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ214563Medicare PIN