Provider Demographics
NPI:1437960374
Name:CHANDLER, GRACE (LLPC)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:CHANDLER
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3014 KNAPP ST NE APT 3J
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-4520
Mailing Address - Country:US
Mailing Address - Phone:616-209-9129
Mailing Address - Fax:
Practice Address - Street 1:3777 44TH ST SE STE 2
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49512-3945
Practice Address - Country:US
Practice Address - Phone:616-209-9192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451024034101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health