Provider Demographics
NPI:1508852856
Name:CHADWELL, ELEANORE JEANINE (LPC)
Entity Type:Individual
Prefix:MS
First Name:ELEANORE
Middle Name:JEANINE
Last Name:CHADWELL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 KIMEL PARK DR
Mailing Address - Street 2:STE 115
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-6951
Mailing Address - Country:US
Mailing Address - Phone:336-768-6930
Mailing Address - Fax:336-768-6328
Practice Address - Street 1:175 KIMEL PARK DR
Practice Address - Street 2:STE 115
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-6951
Practice Address - Country:US
Practice Address - Phone:336-768-6930
Practice Address - Fax:336-768-6328
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC079101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor