Provider Demographics
NPI:1346733417
Name:ALBRITTON, CHANDRA NICOLE (LPC)
Entity Type:Individual
Prefix:
First Name:CHANDRA
Middle Name:NICOLE
Last Name:ALBRITTON
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 1:836 TRADE WIND RD
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31206-3785
Mailing Address - Country:US
Mailing Address - Phone:478-832-2746
Mailing Address - Fax:
Practice Address - Street 1:836 TRADE WIND RD
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31206-3785
Practice Address - Country:US
Practice Address - Phone:478-832-2746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC010085101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional