Provider Demographics
NPI:1457024010
Name:VIRDEN, CHANTA C (LPC)
Entity Type:Individual
Prefix:
First Name:CHANTA
Middle Name:C
Last Name:VIRDEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:CHANTA
Other - Middle Name:C
Other - Last Name:WALTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC-INTERN
Mailing Address - Street 1:5575 WARREN PKWY STE 120
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-4093
Mailing Address - Country:US
Mailing Address - Phone:469-252-0109
Mailing Address - Fax:
Practice Address - Street 1:5575 WARREN PKWY STE 120
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-4093
Practice Address - Country:US
Practice Address - Phone:469-252-0109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-29
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81170101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty