Provider Demographics
NPI:1205144953
Name:CHANDLER, ABIGAIL FAYE (MSN, PMHNP-BC/C, LPC)
Entity type:Individual
Prefix:MS
First Name:ABIGAIL
Middle Name:FAYE
Last Name:CHANDLER
Suffix:
Gender:F
Credentials:MSN, PMHNP-BC/C, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 UPTOWN DR STE 204-11
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-5617
Mailing Address - Country:US
Mailing Address - Phone:248-364-3994
Mailing Address - Fax:
Practice Address - Street 1:122 UPTOWN DR STE 204-11
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-5617
Practice Address - Country:US
Practice Address - Phone:248-364-3994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-15
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401011711101Y00000X
MI4704324517363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor