Provider Demographics
NPI:1003441007
Name:ETHERIDGE, CHELSEA ELIZABETH (LCMHC)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:ELIZABETH
Last Name:ETHERIDGE
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 SUNNY HILL LN
Mailing Address - Street 2:
Mailing Address - City:MILL SPRING
Mailing Address - State:NC
Mailing Address - Zip Code:28756-0646
Mailing Address - Country:US
Mailing Address - Phone:903-253-2921
Mailing Address - Fax:903-253-2921
Practice Address - Street 1:324 SUNNY HILL LN
Practice Address - Street 2:
Practice Address - City:MILL SPRING
Practice Address - State:NC
Practice Address - Zip Code:28756-0646
Practice Address - Country:US
Practice Address - Phone:903-253-2921
Practice Address - Fax:903-253-2921
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73823101YM0800X
NC17874101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health