Provider Demographics
NPI:1235835406
Name:FOARD, CHANDRA SHAKIRA (LPC)
Entity Type:Individual
Prefix:MS
First Name:CHANDRA
Middle Name:SHAKIRA
Last Name:FOARD
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 1:302 VENETIAN WAY
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-4723
Mailing Address - Country:US
Mailing Address - Phone:662-722-2494
Mailing Address - Fax:
Practice Address - Street 1:302 VENETIAN WAY
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-4723
Practice Address - Country:US
Practice Address - Phone:662-722-2494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2850101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health