Provider Demographics
NPI:1902135304
Name:CHANEY, RITA ANN (MS, LMHC)
Entity Type:Individual
Prefix:MS
First Name:RITA
Middle Name:ANN
Last Name:CHANEY
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3479 SHAWN ST
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33980-8660
Mailing Address - Country:US
Mailing Address - Phone:941-624-0210
Mailing Address - Fax:
Practice Address - Street 1:153 CENTER RD
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-5572
Practice Address - Country:US
Practice Address - Phone:941-408-8988
Practice Address - Fax:941-408-8846
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-14
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 8426101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health