Healthcare Provider Details

I. General information

NPI: 1356575021
Provider Name (Legal Business Name): CHANDRA MALETTE CAPLE M.ED, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2009
Last Update Date: 06/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 WRENN MEMORIAL ROAD, HWY 65
WENTWORTH NC
27375-0038
US

IV. Provider business mailing address

PO BOX 38
WENTWORTH NC
27375-0038
US

V. Phone/Fax

Practice location:
  • Phone: 336-342-4261
  • Fax:
Mailing address:
  • Phone: 336-342-4261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number3740
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: