Provider Demographics
NPI:1053066639
Name:CHRYSALIS CONSULTING AND THERAPEUTIC SERVICES, LLC
Entity Type:Organization
Organization Name:CHRYSALIS CONSULTING AND THERAPEUTIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WALTRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:STANCELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-821-0539
Mailing Address - Street 1:7107 NIMITZ DR
Mailing Address - Street 2:
Mailing Address - City:DISTRICT HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20747-3314
Mailing Address - Country:US
Mailing Address - Phone:240-821-0539
Mailing Address - Fax:
Practice Address - Street 1:7107 NIMITZ DR
Practice Address - Street 2:
Practice Address - City:DISTRICT HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20747-3314
Practice Address - Country:US
Practice Address - Phone:240-821-0539
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-13
Last Update Date:2022-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty