Individual
CHANTEL BAUCUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1905 SUNNYSIDE AVE, HOPEWELL, VA 23860-7124
(434) 250-4591
Mailing address
1905 SUNNYSIDE AVE, HOPEWELL, VA 23860-7124
(434) 250-4591
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
920759686
—
VA
Enumeration date
10/13/2022
Last updated
10/21/2022
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