Provider Demographics
NPI:1700419645
Name:CHANDLER, DEMITRA
Entity Type:Individual
Prefix:
First Name:DEMITRA
Middle Name:
Last Name:CHANDLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 RIVER CREST WAY
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22405
Mailing Address - Country:US
Mailing Address - Phone:703-981-2399
Mailing Address - Fax:
Practice Address - Street 1:92 MAIN ST
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-3366
Practice Address - Country:US
Practice Address - Phone:703-981-2399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-19
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health