Healthcare Provider Details

I. General information

NPI: 1033040167
Provider Name (Legal Business Name): ANNIE-KATE ELIZABETH CHAMPAGNE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANNIE CHAMPAGNE

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 WHITLOCK AVE NW
MARIETTA GA
30064
US

IV. Provider business mailing address

1458 HICKORY BRANCH TRL NW
KENNESAW GA
30152-7724
US

V. Phone/Fax

Practice location:
  • Phone: 770-415-0880
  • Fax:
Mailing address:
  • Phone: 770-685-5804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: