Provider Demographics
NPI:1437278371
Name:SUMLIN, CHANDRA R (LPC)
Entity Type:Individual
Prefix:MRS
First Name:CHANDRA
Middle Name:R
Last Name:SUMLIN
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 1:2208 HIGHWAY 39 N
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-2605
Mailing Address - Country:US
Mailing Address - Phone:601-482-2400
Mailing Address - Fax:
Practice Address - Street 1:2208 HIGHWAY 39 N
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-1021
Practice Address - Country:US
Practice Address - Phone:601-482-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR886070163W00000X, 363LP0808X
AL1-152564163W00000X, 363LP0808X
MS0890101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0890OtherLICENSED
MS09532822Medicaid
MS$$$$$$$$$AOtherBLUE CROSS BLUE SHIELD
MS$$$$$$$$$AOtherBLUE CROSS BLUE SHIELD