Provider Demographics
NPI:1851699250
Name:CHAPMAN, CONSUELA (LCSW, LCAS)
Entity Type:Individual
Prefix:
First Name:CONSUELA
Middle Name:
Last Name:CHAPMAN
Suffix:
Gender:F
Credentials:LCSW, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 W MARTIN ST
Mailing Address - Street 2:STE 206
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27601-2948
Mailing Address - Country:US
Mailing Address - Phone:919-641-2377
Mailing Address - Fax:
Practice Address - Street 1:5511 RAEFORD RD STE 204
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-2059
Practice Address - Country:US
Practice Address - Phone:910-689-5333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-09
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0105681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty