Provider Demographics
NPI:1679686729
Name:CHANCEY, NANCY ELIZABETH (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:ELIZABETH
Last Name:CHANCEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4528 LICKSKILLET RD
Mailing Address - Street 2:
Mailing Address - City:BLUE RIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30513-3446
Mailing Address - Country:US
Mailing Address - Phone:706-258-3219
Mailing Address - Fax:
Practice Address - Street 1:245 HARMONY LANE
Practice Address - Street 2:
Practice Address - City:BLUE RIDGE
Practice Address - State:GA
Practice Address - Zip Code:30513
Practice Address - Country:US
Practice Address - Phone:706-258-3219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW002895101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00929629AMedicaid
GA00929629AMedicaid