Provider Demographics
NPI:1497111876
Name:VICKS, CHANTEL MARIE (MA)
Entity Type:Individual
Prefix:
First Name:CHANTEL
Middle Name:MARIE
Last Name:VICKS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 W KRUEGER LN
Mailing Address - Street 2:
Mailing Address - City:WESTWEGO
Mailing Address - State:LA
Mailing Address - Zip Code:70094-3712
Mailing Address - Country:US
Mailing Address - Phone:504-487-0503
Mailing Address - Fax:
Practice Address - Street 1:2400 VETERANS MEMORIAL BLVD
Practice Address - Street 2:SUITE 215
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70062-4715
Practice Address - Country:US
Practice Address - Phone:504-405-5280
Practice Address - Fax:504-405-5434
Is Sole Proprietor?:No
Enumeration Date:2016-01-14
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health