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General NPI Number Information
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NPI Number | 1083067862
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Entity Type | Individual
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Provider Name | CHALENE MICHELLE GARDENHIRE LCSW
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Gender | Female
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Dates
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Enumeration Date | 07/18/2016
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Last Update Date | 06/05/2025
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Provider Practice Location Address
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Address Line | 1230 PEACHTREE ST NE FL 19
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City | ATLANTA
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State | GA
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Zip | 30309-3574
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Country | US
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Telephone | 657-400-5180
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Fax |
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Provider Business Mailing Address
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Address Line | 267 LANGLEY DR # 1001
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-6907
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Country | US
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Telephone | 470-202-8779
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 111310
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW005765
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW005765
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License Number State | GA
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