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General NPI Number Information
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NPI Number | 1629588041
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Entity Type | Individual
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Provider Name | CHANDRA DEW LPC
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Gender | Female
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Dates
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Enumeration Date | 10/11/2017
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Last Update Date | 12/22/2023
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Provider Practice Location Address
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Address Line | 5435 SUGARLOAF PKWY STE 2201
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-5763
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Country | US
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Telephone | 770-875-2595
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Fax |
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Provider Business Mailing Address
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Address Line | 5425 SUGARLOAF PKWY STE 1101
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-5705
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Country | US
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Telephone | 770-875-2595
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Fax |
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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 | LPC009805
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License Number State | GA
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