Provider Demographics
NPI:1659709970
Name:MCCORD, CHANEL (MA, LPC)
Entity Type:Individual
Prefix:
First Name:CHANEL
Middle Name:
Last Name:MCCORD
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:CHANEL
Other - Middle Name:
Other - Last Name:GRATE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:770 WOODLANE RD
Mailing Address - Street 2:
Mailing Address - City:MT. HOLLY
Mailing Address - State:NJ
Mailing Address - Zip Code:08060
Mailing Address - Country:US
Mailing Address - Phone:609-267-5928
Mailing Address - Fax:
Practice Address - Street 1:614 STATION AVE
Practice Address - Street 2:
Practice Address - City:HADDON HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08035-1907
Practice Address - Country:US
Practice Address - Phone:609-534-0219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-23
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00182200101YM0800X
NJ37PC00598300101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health