Provider Demographics
NPI:1043591910
Name:CHANDLER, SHARON L (LAC,CCGC,CCDP)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:L
Last Name:CHANDLER
Suffix:
Gender:F
Credentials:LAC,CCGC,CCDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 E GEORGIA AVE
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-3931
Mailing Address - Country:US
Mailing Address - Phone:318-251-4125
Mailing Address - Fax:318-251-5000
Practice Address - Street 1:602 E GEORGIA AVE
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-3931
Practice Address - Country:US
Practice Address - Phone:318-251-4125
Practice Address - Fax:318-251-5000
Is Sole Proprietor?:No
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1224101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)