Provider Demographics
NPI:1821166778
Name:FAULCONER, CHAPIN (LPC)
Entity Type:Individual
Prefix:MS
First Name:CHAPIN
Middle Name:
Last Name:FAULCONER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BOARS HEAD PL
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-4628
Mailing Address - Country:US
Mailing Address - Phone:434-996-6362
Mailing Address - Fax:
Practice Address - Street 1:1 BOARS HEAD PL
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-4628
Practice Address - Country:US
Practice Address - Phone:434-996-6362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003721101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor