Provider Demographics
NPI:1407357205
Name:CHAFFOULD, HEATHER ELAINE (CIT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ELAINE
Last Name:CHAFFOULD
Suffix:
Gender:F
Credentials:CIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2829 4TH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-7834
Mailing Address - Country:US
Mailing Address - Phone:337-433-8281
Mailing Address - Fax:337-433-7938
Practice Address - Street 1:2829 4TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-7834
Practice Address - Country:US
Practice Address - Phone:337-433-8281
Practice Address - Fax:337-433-7938
Is Sole Proprietor?:No
Enumeration Date:2018-02-27
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4064101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)