Provider Demographics
NPI:1801685052
Name:CHRYSALIS COUNSELING, LLC
Entity type:Organization
Organization Name:CHRYSALIS COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:GOODPASTER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:334-494-8039
Mailing Address - Street 1:1210 RUCKER BLVD
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36330-3625
Mailing Address - Country:US
Mailing Address - Phone:334-417-0236
Mailing Address - Fax:
Practice Address - Street 1:1210 RUCKER BLVD
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-3625
Practice Address - Country:US
Practice Address - Phone:334-417-0236
Practice Address - Fax:334-366-3627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)