Healthcare Provider Details

I. General information

NPI: 1083981849
Provider Name (Legal Business Name): LEJEUNE CHANDLER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2011
Last Update Date: 11/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6300 OLD CANTON RD 15103
JACKSON MS
39211-2441
US

IV. Provider business mailing address

6300 OLD CANTON RD 15103
JACKSON MS
39211-2441
US

V. Phone/Fax

Practice location:
  • Phone: 601-842-6666
  • Fax:
Mailing address:
  • Phone: 601-842-6666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC7564
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: