Provider Demographics
NPI:1831663103
Name:HEMMINGWAY-CHANDLER, PHACIEALEETHAS JUANTRICE (LPC, RPT, CTMH, NCC)
Entity Type:Individual
Prefix:
First Name:PHACIEALEETHAS
Middle Name:JUANTRICE
Last Name:HEMMINGWAY-CHANDLER
Suffix:
Gender:F
Credentials:LPC, RPT, CTMH, NCC
Other - Prefix:
Other - First Name:PJ
Other - Middle Name:
Other - Last Name:CHANDLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1985
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-1720
Mailing Address - Country:US
Mailing Address - Phone:404-402-9213
Mailing Address - Fax:
Practice Address - Street 1:2510 SADDLECREEK DR
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-8952
Practice Address - Country:US
Practice Address - Phone:678-829-8166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-18
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
GA010558101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health