Provider Demographics
NPI:1609589415
Name:CHANDLER, MYLAH MURIN (MSW, LCSWA)
Entity Type:Individual
Prefix:
First Name:MYLAH
Middle Name:MURIN
Last Name:CHANDLER
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5104 REAGAN DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28206-1396
Mailing Address - Country:US
Mailing Address - Phone:704-596-0505
Mailing Address - Fax:
Practice Address - Street 1:1816 E 7TH ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2416
Practice Address - Country:US
Practice Address - Phone:704-780-4977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-27
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0185541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical