Provider Demographics
NPI:1376187138
Name:GLADDEN, CHANTEL (LPC, LCPC)
Entity Type:Individual
Prefix:MRS
First Name:CHANTEL
Middle Name:
Last Name:GLADDEN
Suffix:
Gender:F
Credentials:LPC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 INDUSTRIAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-2708
Mailing Address - Country:US
Mailing Address - Phone:757-753-0841
Mailing Address - Fax:
Practice Address - Street 1:75 INDUSTRIAL PARK DR
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-2708
Practice Address - Country:US
Practice Address - Phone:301-645-1837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-04
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701007848101YP2500X
MDLC9928101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional