Provider Demographics
NPI:1255758702
Name:CHANDLER, YVETTE
Entity type:Individual
Prefix:
First Name:YVETTE
Middle Name:
Last Name:CHANDLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22190 GARRISON
Mailing Address - Street 2:STE 204
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2234
Mailing Address - Country:US
Mailing Address - Phone:248-259-9157
Mailing Address - Fax:
Practice Address - Street 1:22190 GARRISON
Practice Address - Street 2:STE 204
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2234
Practice Address - Country:US
Practice Address - Phone:248-259-9157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-22
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013904101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor