Healthcare Provider Details

I. General information

NPI: 1700320249
Provider Name (Legal Business Name): CHELSEY BROOKS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2016
Last Update Date: 12/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19441 GOLF VISTA PLZ SUITE 110
LANSDOWNE VA
20176-8269
US

IV. Provider business mailing address

26029 HUNTWICK GLEN SQ # QU
ALDIE VA
20105-5716
US

V. Phone/Fax

Practice location:
  • Phone: 518-573-9007
  • Fax:
Mailing address:
  • Phone: 518-573-9007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701006881
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: