Healthcare Provider Details

I. General information

NPI: 1992619902
Provider Name (Legal Business Name): KATHRYN ROSE CHANDA MA, LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3275 VANCE RD
EAST JORDAN MI
49727-9234
US

IV. Provider business mailing address

3275 VANCE RD
EAST JORDAN MI
49727-9234
US

V. Phone/Fax

Practice location:
  • Phone: 231-430-1590
  • Fax:
Mailing address:
  • Phone: 231-430-1590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6451025284
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: