Healthcare Provider Details

I. General information

NPI: 1710475017
Provider Name (Legal Business Name): AYONNA M CHAPPELL MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AYONNA M MCCULLOUGH MA LPC

II. Dates (important events)

Enumeration Date: 04/23/2018
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1372 ROSEVILLE DR
COLORADO SPRINGS CO
80911-3860
US

IV. Provider business mailing address

1372 ROSEVILLE DR
COLORADO SPRINGS CO
80911-3860
US

V. Phone/Fax

Practice location:
  • Phone: 843-304-3372
  • Fax:
Mailing address:
  • Phone: 843-304-3372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0013779
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: