Provider Demographics
NPI:1215216023
Name:CHANEY, MARQUESHA LACHELLE (LPC)
Entity Type:Individual
Prefix:
First Name:MARQUESHA
Middle Name:LACHELLE
Last Name:CHANEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3407 SHAMROCK CT
Mailing Address - Street 2:
Mailing Address - City:GAUTIER
Mailing Address - State:MS
Mailing Address - Zip Code:39553-6429
Mailing Address - Country:US
Mailing Address - Phone:228-497-0690
Mailing Address - Fax:228-497-1363
Practice Address - Street 1:3407 SHAMROCK CT
Practice Address - Street 2:
Practice Address - City:GAUTIER
Practice Address - State:MS
Practice Address - Zip Code:39553-6429
Practice Address - Country:US
Practice Address - Phone:228-497-0690
Practice Address - Fax:228-497-1363
Is Sole Proprietor?:No
Enumeration Date:2011-08-10
Last Update Date:2020-04-20
Deactivation Date:2020-02-07
Deactivation Code:
Reactivation Date:2020-03-26
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00018214Medicaid