Provider Demographics
NPI:1609012186
Name:CHANDLER, SHIRLEY KAY (PHD, LPC, CRC)
Entity Type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:KAY
Last Name:CHANDLER
Suffix:
Gender:F
Credentials:PHD, LPC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2004 GA HIGHWAY 122
Mailing Address - Street 2:SUITE 7
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31757-2543
Mailing Address - Country:US
Mailing Address - Phone:229-228-6182
Mailing Address - Fax:229-228-4349
Practice Address - Street 1:2004 GA HIGHWAY 122
Practice Address - Street 2:SUITE 7
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31757-2543
Practice Address - Country:US
Practice Address - Phone:229-228-6182
Practice Address - Fax:229-228-4349
Is Sole Proprietor?:No
Enumeration Date:2009-01-05
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005497101YA0400X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health