Provider Demographics
NPI:1316577299
Name:MOSSINE, CHANDRA HOPE
Entity Type:Individual
Prefix:
First Name:CHANDRA
Middle Name:HOPE
Last Name:MOSSINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 SAINT CHRISTOPHER ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-2355
Mailing Address - Country:US
Mailing Address - Phone:573-825-8895
Mailing Address - Fax:
Practice Address - Street 1:2012 CHERRY HILL DR STE 102B
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-5882
Practice Address - Country:US
Practice Address - Phone:573-891-1330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-20
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019037134101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional