Provider Demographics
NPI:1629774286
Name:BOYDEN-DEIDRICK, CHANDA ELAINE (MSW, LCSW, LISW)
Entity Type:Individual
Prefix:MS
First Name:CHANDA
Middle Name:ELAINE
Last Name:BOYDEN-DEIDRICK
Suffix:
Gender:F
Credentials:MSW, LCSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1731 E COUNTY ROAD 600 N
Mailing Address - Street 2:
Mailing Address - City:PITTSBORO
Mailing Address - State:IN
Mailing Address - Zip Code:46167-9011
Mailing Address - Country:US
Mailing Address - Phone:317-938-8517
Mailing Address - Fax:
Practice Address - Street 1:1731 E COUNTY ROAD 600 N
Practice Address - Street 2:
Practice Address - City:PITTSBORO
Practice Address - State:IN
Practice Address - Zip Code:46167-9011
Practice Address - Country:US
Practice Address - Phone:317-938-8517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-06
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.22037411041C0700X
IN34007615A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical