Provider Demographics
NPI:1235998220
Name:WEAVER, CHELSEA ALEXUS (MED LPC)
Entity Type:Individual
Prefix:MRS
First Name:CHELSEA
Middle Name:ALEXUS
Last Name:WEAVER
Suffix:
Gender:F
Credentials:MED LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 S WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-5418
Mailing Address - Country:US
Mailing Address - Phone:912-493-7783
Mailing Address - Fax:
Practice Address - Street 1:337 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-5418
Practice Address - Country:US
Practice Address - Phone:912-493-7783
Practice Address - Fax:912-205-6876
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC014345101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor