Healthcare Provider Details

I. General information

NPI: 1104757335
Provider Name (Legal Business Name): LAUREN CHAPPUIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAUREN CLINE LCSW

II. Dates (important events)

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

III. Provider practice location address

77 COLE ST NE
MARIETTA GA
30060-2030
US

IV. Provider business mailing address

77 COLE ST NE
MARIETTA GA
30060-2030
US

V. Phone/Fax

Practice location:
  • Phone: 770-713-9656
  • Fax:
Mailing address:
  • Phone: 770-713-9656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW009893
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: