Healthcare Provider Details

I. General information

NPI: 1346741717
Provider Name (Legal Business Name): CHELSEA ALEXANDRA KINNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2018
Last Update Date: 02/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HUNTINGTON RD STE 801
ATHENS GA
30606-7216
US

IV. Provider business mailing address

1530 MERIWEATHER DR APT 104
WATKINSVILLE GA
30677-6925
US

V. Phone/Fax

Practice location:
  • Phone: 706-552-0450
  • Fax:
Mailing address:
  • Phone: 706-296-6285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: