Provider Demographics
NPI:1346280898
Name:CHAPMAN, JOHNNY LEO SR
Entity Type:Individual
Prefix:MR
First Name:JOHNNY
Middle Name:LEO
Last Name:CHAPMAN
Suffix:SR
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:JOHNNY
Other - Middle Name:LEO
Other - Last Name:CHAPMAN
Other - Suffix:SR
Other - Last Name Type:Professional Name
Other - Credentials:SOCIAL WORKER
Mailing Address - Street 1:5637 N LAKE DR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019-2537
Mailing Address - Country:US
Mailing Address - Phone:540-982-2463
Mailing Address - Fax:
Practice Address - Street 1:1970 ROANOKE BLVD
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-6404
Practice Address - Country:US
Practice Address - Phone:540-982-2463
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker