Healthcare Provider Details

I. General information

NPI: 1851216972
Provider Name (Legal Business Name): CARISSA CHANDLER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 ENTERPRISE DR STE A
OXFORD MS
38655-2762
US

IV. Provider business mailing address

93 COUNTY ROAD 370
OXFORD MS
38655-9506
US

V. Phone/Fax

Practice location:
  • Phone: 662-638-3026
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3127
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: