Healthcare Provider Details

I. General information

NPI: 1588575187
Provider Name (Legal Business Name): KIMBERLY CHANDLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 SUFFOLK AVE STE 1
RICHLANDS VA
24641-2434
US

IV. Provider business mailing address

169 SUFFOLK AVE STE 1
RICHLANDS VA
24641-2434
US

V. Phone/Fax

Practice location:
  • Phone: 276-963-0111
  • Fax: 276-963-0005
Mailing address:
  • Phone: 276-963-0111
  • Fax: 276-963-0005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701016742
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: