Basic Information
| Provider Information | |||||||||
| NPI: | 1346280898 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHAPMAN | ||||||||
| FirstName: | JOHNNY | ||||||||
| MiddleName: | LEO | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | SR. | ||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CHAPMAN | ||||||||
| OtherFirstName: | JOHNNY | ||||||||
| OtherMiddleName: | LEO | ||||||||
| OtherNamePrefix: | MR. | ||||||||
| OtherNameSuffix: | SR. | ||||||||
| OtherCredential: | SOCIAL WORKER | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 5637 N LAKE DR | ||||||||
| Address2: | |||||||||
| City: | ROANOKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240192537 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5409822463 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1970 ROANOKE BLVD | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | VA | ||||||||
| PostalCode: | 241536404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5409822463 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.