Healthcare Provider Details

I. General information

NPI: 1952886525
Provider Name (Legal Business Name): CASSANDRA JO CHAPMAN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2018
Last Update Date: 06/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

689 CENTRAL AVE
BARBOURSVILLE WV
25504-1315
US

IV. Provider business mailing address

157 HONEYSUCKLE LN
HUNTINGTON WV
25701-4725
US

V. Phone/Fax

Practice location:
  • Phone: 304-733-3331
  • Fax: 304-733-3334
Mailing address:
  • Phone: 304-730-2239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2432
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: