Provider Demographics
NPI:1457890907
Name:CHANEY, MICHELLE (LCPC, CAC-AD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:CHANEY
Suffix:
Gender:F
Credentials:LCPC, CAC-AD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11810 GRAND PARK AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:NORTH BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20852-8679
Mailing Address - Country:US
Mailing Address - Phone:240-547-9316
Mailing Address - Fax:
Practice Address - Street 1:11810 GRAND PARK AVE STE 500
Practice Address - Street 2:
Practice Address - City:NORTH BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20852-8679
Practice Address - Country:US
Practice Address - Phone:240-547-9316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-16
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC1819101YA0400X, 101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1028015Medicaid