Provider Demographics
NPI:1104397314
Name:ALLEN, CHANDA DENISE (CDP)
Entity Type:Individual
Prefix:MS
First Name:CHANDA
Middle Name:DENISE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 45TH ST NE STE C
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-1303
Mailing Address - Country:US
Mailing Address - Phone:253-289-6233
Mailing Address - Fax:253-859-0789
Practice Address - Street 1:721 45TH ST NE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-1303
Practice Address - Country:US
Practice Address - Phone:253-289-6233
Practice Address - Fax:253-859-0789
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60171129101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACP60171129OtherCHEMICAL DEPENDENCY PROFESSIONAL