Provider Demographics
NPI:1366282519
Name:PALACIOS-HADLOCK, CHANDA J (LPCC, LADC)
Entity type:Individual
Prefix:MS
First Name:CHANDA
Middle Name:J
Last Name:PALACIOS-HADLOCK
Suffix:
Gender:F
Credentials:LPCC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-3656
Mailing Address - Country:US
Mailing Address - Phone:612-449-1144
Mailing Address - Fax:612-871-0929
Practice Address - Street 1:2211 CLINTON AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-3656
Practice Address - Country:US
Practice Address - Phone:612-449-1144
Practice Address - Fax:612-871-0929
Is Sole Proprietor?:No
Enumeration Date:2024-05-27
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN303459101YA0400X
MNCC04417101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)