Provider Demographics
NPI:1174019467
Name:CHANDLER, CHRISTIE LADONNA (HHP)
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:LADONNA
Last Name:CHANDLER
Suffix:
Gender:F
Credentials:HHP
Other - Prefix:
Other - First Name:CHRISTIE
Other - Middle Name:
Other - Last Name:HOMECARE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CEO
Mailing Address - Street 1:8401 KENNEDY CIR UNIT 3
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-2223
Mailing Address - Country:US
Mailing Address - Phone:586-843-7880
Mailing Address - Fax:
Practice Address - Street 1:8401 KENNEDY CIR UNIT 3
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-2223
Practice Address - Country:US
Practice Address - Phone:586-843-7880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-10
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service