Provider Demographics
NPI:1023387925
Name:VARNADO-JOHNSON, CHANTRELLE DERON (PHD, LPC-S, NCC)
Entity Type:Individual
Prefix:DR
First Name:CHANTRELLE
Middle Name:DERON
Last Name:VARNADO-JOHNSON
Suffix:
Gender:F
Credentials:PHD, LPC-S, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2075 DEPT OF PSYCHOLOGY COUNSELING & FAMILY
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70310-0001
Mailing Address - Country:US
Mailing Address - Phone:985-448-4349
Mailing Address - Fax:854-484-4435
Practice Address - Street 1:906 EAST 1ST STRET
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70310-5848
Practice Address - Country:US
Practice Address - Phone:985-448-4349
Practice Address - Fax:985-448-4435
Is Sole Proprietor?:No
Enumeration Date:2011-12-21
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3895101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional