Provider Demographics
NPI:1770235699
Name:CHAU, CHANLLYCA (MS)
Entity Type:Individual
Prefix:
First Name:CHANLLYCA
Middle Name:
Last Name:CHAU
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5512 GARDEN GROVE CIR
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-7362
Mailing Address - Country:US
Mailing Address - Phone:904-860-4074
Mailing Address - Fax:
Practice Address - Street 1:3544 EDGEWATER DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-2922
Practice Address - Country:US
Practice Address - Phone:407-291-8009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-21
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
1918OtherANNIVERSARIES