Provider Demographics
NPI:1790802536
Name:CHAPPELL, JUDITH W (LCAS, LPCA)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:W
Last Name:CHAPPELL
Suffix:
Gender:F
Credentials:LCAS, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2783 NC HIGHWAY 68 S STE 104
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-8325
Mailing Address - Country:US
Mailing Address - Phone:191-033-1003
Mailing Address - Fax:704-983-3919
Practice Address - Street 1:225 N MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NC
Practice Address - Zip Code:27371-3062
Practice Address - Country:US
Practice Address - Phone:910-330-0033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9397101YM0800X
NCA9397101YP2500X
NC2070101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6112392Medicaid