Provider Demographics
NPI:1790145233
Name:STANLEY, CHANESSA (MS)
Entity Type:Individual
Prefix:
First Name:CHANESSA
Middle Name:
Last Name:STANLEY
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 1:2607 WELSH RD APT L305
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-3340
Mailing Address - Country:US
Mailing Address - Phone:302-507-0392
Mailing Address - Fax:
Practice Address - Street 1:2607 WELSH RD APT L305
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-3340
Practice Address - Country:US
Practice Address - Phone:302-507-0392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-25
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health