MEDICARE: PAUL RAYMOND CHIPMAN II LPC

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	101YP2500X	Professional Counselor	0701008405	VA

General Provider Information

NPI Number	:	1407418437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL RAYMOND CHIPMAN II LPC

Provider Business Mailing Address
First Line	:	4615 LAKEFIELD MEWS PL APT F
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23231-4188
Country	:	US
Telephone Number	:	804-387-9127
Fax Number	:

Provider Business Practice Location Address
First Line	:	13354 MIDLOTHIAN TPKE
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23113-4258
Country	:	US
Telephone Number	:	804-277-9355
Fax Number	:

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

Provider Enumeration Date	:	06/29/2019
Last Update Date	:	06/29/2019

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