Healthcare Provider Details

I. General information

NPI: 1083784417
Provider Name (Legal Business Name): DAIRLYN J CHELETTE MSW LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 01/30/2022
Certification Date: 01/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 BUFORD HWY NE STE 508
BROOKHAVEN GA
30329-2137
US

IV. Provider business mailing address

2801 BUFORD HWY NE STE 508
BROOKHAVEN GA
30329-2137
US

V. Phone/Fax

Practice location:
  • Phone: 678-397-1189
  • Fax:
Mailing address:
  • Phone: 770-446-5642
  • Fax: 770-446-5643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW000477
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: