Healthcare Provider Details

I. General information

NPI: 1144942814
Provider Name (Legal Business Name): CHAUNTEL HERROD NBHWC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2022
Last Update Date: 09/19/2022
Certification Date: 09/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 N SAINT PAUL ST STE 3100
DALLAS TX
75201-3923
US

IV. Provider business mailing address

3290 COBB GALLERIA PKWY UNIT 15191
ATLANTA GA
30339-5984
US

V. Phone/Fax

Practice location:
  • Phone: 646-389-3451
  • Fax:
Mailing address:
  • Phone: 404-563-1666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: