Healthcare Provider Details

I. General information

NPI: 1912689100
Provider Name (Legal Business Name): CHELSEA HUNTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2023
Last Update Date: 08/07/2023
Certification Date: 08/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 CAMPBELL HILL ST NW
MARIETTA GA
30060-1134
US

IV. Provider business mailing address

34 BYRON CT
HIRAM GA
30141-5704
US

V. Phone/Fax

Practice location:
  • Phone: 770-603-0123
  • Fax:
Mailing address:
  • Phone: 678-467-8679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: