Provider Demographics
NPI:1699493601
Name:PARDUE, CHELSEA GILLISPIE (LCSW)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:GILLISPIE
Last Name:PARDUE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9595 AIRPOINT DR
Mailing Address - Street 2:
Mailing Address - City:BENT MOUNTAIN
Mailing Address - State:VA
Mailing Address - Zip Code:24059-2007
Mailing Address - Country:US
Mailing Address - Phone:540-493-3390
Mailing Address - Fax:
Practice Address - Street 1:2840 ELECTRIC RD
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-3551
Practice Address - Country:US
Practice Address - Phone:540-772-5140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-16
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040136911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical