Provider Demographics
NPI:1396890489
Name:CHANDLER, NILS BETHEL (LPC)
Entity type:Individual
Prefix:
First Name:NILS
Middle Name:BETHEL
Last Name:CHANDLER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 CENTRAL HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:FORT EISENHOWER
Mailing Address - State:GA
Mailing Address - Zip Code:30905-6003
Mailing Address - Country:US
Mailing Address - Phone:706-787-2876
Mailing Address - Fax:706-787-8286
Practice Address - Street 1:234 CENTRAL HOSPITAL RD BLDG 329
Practice Address - Street 2:
Practice Address - City:FORT EISENHOWER
Practice Address - State:GA
Practice Address - Zip Code:30905-6003
Practice Address - Country:US
Practice Address - Phone:706-787-2876
Practice Address - Fax:706-787-8682
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1780101YA0400X
GANCACI013944101YA0400X
GANCC88694101YM0800X
GALPC004710101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health