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General NPI Number Information
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NPI Number | 1235488198
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Entity Type | Individual
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Provider Name | CHASTITY DRAKE LPC
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Gender | Female
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Dates
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Enumeration Date | 09/06/2012
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Last Update Date | 09/06/2012
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Provider Practice Location Address
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Address Line | 2519 N HILLCREST PKWY, STE 201
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City | ALTOONA
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State | WI
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Zip | 54720-2588
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Country | US
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Telephone | 715-832-8432
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Fax | 715-832-5007
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Provider Business Mailing Address
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Address Line | 2519 N HILLCREST PKWY, STE 201
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City | ALTOONA
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State | WI
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Zip | 54720-2588
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Country | US
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Telephone | 715-832-8432
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Fax | 715-832-5007
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 4872-125
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License Number State | WI
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