MEDICARE: ANNIE-KATE ELIZABETH CHAMPAGNE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor		GA

General Provider Information

NPI Number	:	1033040167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNIE-KATE ELIZABETH CHAMPAGNE

Provider Business Mailing Address
First Line	:	1458 HICKORY BRANCH TRL NW
Second Line	:
City	:	KENNESAW
State	:	GA
Zip	:	30152-7724
Country	:	US
Telephone Number	:	770-685-5804
Fax Number	:

Provider Business Practice Location Address
First Line	:	707 WHITLOCK AVE NW
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30064
Country	:	US
Telephone Number	:	770-415-0880
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2026
Last Update Date	:	05/27/2026

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