Provider Demographics
NPI:1659923217
Name:PANCHURA, CHASIDY NICOLE (NCC, LPC)
Entity Type:Individual
Prefix:
First Name:CHASIDY
Middle Name:NICOLE
Last Name:PANCHURA
Suffix:
Gender:F
Credentials:NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 WAYNE DR
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-4987
Mailing Address - Country:US
Mailing Address - Phone:717-773-2801
Mailing Address - Fax:
Practice Address - Street 1:100 WINDING CREEK BLVD # 3
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-1883
Practice Address - Country:US
Practice Address - Phone:717-590-7283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-14
Last Update Date:2019-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC011591101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional