MEDICARE: DR. JOAN AUSTIN GRACE CHANDLER PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	2113	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265430540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOAN AUSTIN GRACE CHANDLER PH.D.

Provider Business Mailing Address
First Line	:	8200 CROWS NEST LN
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27455-9294
Country	:	US
Telephone Number	:	336-643-5885
Fax Number	:	336-643-6850

Provider Business Practice Location Address
First Line	:	8200 CROWS NEST LN
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27455-9294
Country	:	US
Telephone Number	:	336-643-5885
Fax Number	:	336-643-6850

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	05/21/2010

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