Provider Demographics
NPI:1124994165
Name:SYLVESTRE, CHANICE DORI-ANN
Entity type:Individual
Prefix:
First Name:CHANICE
Middle Name:DORI-ANN
Last Name:SYLVESTRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHANICE
Other - Middle Name:DORI-ANN
Other - Last Name:SYLVESTRE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:12 JOVITA DR
Mailing Address - Street 2:
Mailing Address - City:PORT WENTWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:31407-1225
Mailing Address - Country:US
Mailing Address - Phone:347-872-1508
Mailing Address - Fax:
Practice Address - Street 1:12 JOVITA DR
Practice Address - Street 2:
Practice Address - City:PORT WENTWORTH
Practice Address - State:GA
Practice Address - Zip Code:31407-1225
Practice Address - Country:US
Practice Address - Phone:347-872-1508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-16
Last Update Date:2025-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW012501101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health