Provider Demographics
NPI:1851984215
Name:SHIRLEY, CHANTAL DANIELLE (RBT)
Entity Type:Individual
Prefix:MS
First Name:CHANTAL
Middle Name:DANIELLE
Last Name:SHIRLEY
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1948 COUNTY ROAD 141
Mailing Address - Street 2:
Mailing Address - City:ARITON
Mailing Address - State:AL
Mailing Address - Zip Code:36311-8663
Mailing Address - Country:US
Mailing Address - Phone:334-367-9578
Mailing Address - Fax:334-397-0058
Practice Address - Street 1:1948 COUNTY ROAD 141
Practice Address - Street 2:
Practice Address - City:ARITON
Practice Address - State:AL
Practice Address - Zip Code:36311-8663
Practice Address - Country:US
Practice Address - Phone:334-367-9578
Practice Address - Fax:334-397-0058
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-17
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALRBT-20-133420106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician