Provider Demographics
NPI:1265249288
Name:CHANDLER, RETA COZETTE (LPC-S)
Entity type:Individual
Prefix:MRS
First Name:RETA
Middle Name:COZETTE
Last Name:CHANDLER
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 MCLAURIN ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-8613
Mailing Address - Country:US
Mailing Address - Phone:601-291-9521
Mailing Address - Fax:
Practice Address - Street 1:505 MCLAURIN ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-8613
Practice Address - Country:US
Practice Address - Phone:601-291-9521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1771101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty