Healthcare Provider Details

I. General information

NPI: 1457890907
Provider Name (Legal Business Name): MICHELLE CHANEY LCPC, CAC-AD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2017
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11810 GRAND PARK AVE STE 500
NORTH BETHESDA MD
20852-8679
US

IV. Provider business mailing address

11810 GRAND PARK AVE STE 500
NORTH BETHESDA MD
20852-8679
US

V. Phone/Fax

Practice location:
  • Phone: 240-547-9316
  • Fax:
Mailing address:
  • Phone: 240-547-9316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC8330
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: