Healthcare Provider Details

I. General information

NPI: 1578084687
Provider Name (Legal Business Name): CHATELAH D BROWN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2017
Last Update Date: 06/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3379 AZTEC ROAD APT. 9D
DULUTH GA
30096-3009
US

IV. Provider business mailing address

3470 MCCLURE BRIDGE RD UNIT 1081
DULUTH GA
30096-1112
US

V. Phone/Fax

Practice location:
  • Phone: 404-808-0287
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberMSW007240
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number715062
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License NumberMSW007240
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: