Provider Demographics
NPI:1356818942
Name:CHANDLER, SHAINA MIRANDA (LPC, CSOTP)
Entity Type:Individual
Prefix:
First Name:SHAINA
Middle Name:MIRANDA
Last Name:CHANDLER
Suffix:
Gender:F
Credentials:LPC, CSOTP
Other - Prefix:
Other - First Name:SHAINA
Other - Middle Name:LEE
Other - Last Name:MIRANDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12800 W CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23238-1116
Mailing Address - Country:US
Mailing Address - Phone:804-314-9117
Mailing Address - Fax:804-784-5261
Practice Address - Street 1:12800 W CREEK PKWY
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23238-1116
Practice Address - Country:US
Practice Address - Phone:804-314-9117
Practice Address - Fax:804-784-5261
Is Sole Proprietor?:No
Enumeration Date:2018-11-01
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701007784101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional