Provider Demographics
NPI:1346573417
Name:CHRYSALIS
Entity Type:Organization
Organization Name:CHRYSALIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PSYCHOTHERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KANDACE
Authorized Official - Middle Name:KOONTZ
Authorized Official - Last Name:PERRYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NCC, NCSC
Authorized Official - Phone:336-885-2116
Mailing Address - Street 1:1312 HAMILTON PL
Mailing Address - Street 2:SUITE 105
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265
Mailing Address - Country:US
Mailing Address - Phone:336-885-2116
Mailing Address - Fax:
Practice Address - Street 1:1312 HAMILTON PL
Practice Address - Street 2:SUITE 105
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265
Practice Address - Country:US
Practice Address - Phone:336-885-2116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4873101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty