Provider Demographics
NPI:1790802536
Name:CHAPPELL, JUDITH W (LCAS, LCMHS, CCS)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:W
Last Name:CHAPPELL
Suffix:
Gender:F
Credentials:LCAS, LCMHS, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1446 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-5236
Mailing Address - Country:US
Mailing Address - Phone:336-780-6507
Mailing Address - Fax:980-581-8093
Practice Address - Street 1:1446 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-5236
Practice Address - Country:US
Practice Address - Phone:336-780-6507
Practice Address - Fax:980-581-8093
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2070101YA0400X, 101YA0400X
NCS9397101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNA3098P368Medicaid
NC6112392Medicaid