Healthcare Provider Details

I. General information

NPI: 1073767174
Provider Name (Legal Business Name): CHANTE WELLINGTON MITCHELL PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHANTE WELLINGTON MITCHELL PH.D.

II. Dates (important events)

Enumeration Date: 11/17/2008
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 KENTUCKY ST
SCOTTDALE GA
30079-1124
US

IV. Provider business mailing address

610 KENTUCKY ST
SCOTTDALE GA
30079-1124
US

V. Phone/Fax

Practice location:
  • Phone: 404-490-6821
  • Fax:
Mailing address:
  • Phone: 404-490-6821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3968
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY004393
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: