Healthcare Provider Details

I. General information

NPI: 1407488968
Provider Name (Legal Business Name): CHRISTINA L CHARETTE PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2020
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 CARL VINSON PKWY SUITE 109
CENTERVILLE GA
31028
US

IV. Provider business mailing address

951 CARL VINSON PKWY SUITE 109
CENTERVILLE GA
31028
US

V. Phone/Fax

Practice location:
  • Phone: 478-888-6023
  • Fax:
Mailing address:
  • Phone: 478-888-6023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number003431
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3923
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY003431
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: