Healthcare Provider Details

I. General information

NPI: 1275489775
Provider Name (Legal Business Name): JOHN CHAPPELL V
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2026
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4835 WATERLICK RD STE A
FOREST VA
24551-1696
US

IV. Provider business mailing address

4835 WATERLICK RD STE A
FOREST VA
24551-1696
US

V. Phone/Fax

Practice location:
  • Phone: 434-515-0531
  • Fax:
Mailing address:
  • Phone: 434-515-0531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0704018936
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: