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General NPI Number Information
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NPI Number | 1710398805
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Entity Type | Individual
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Provider Name | CHAWANIS JEFFERSON ASH MDIV, CADCII, ICADC
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Gender | Female
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Dates
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Enumeration Date | 05/12/2014
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Last Update Date | 05/12/2014
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Provider Practice Location Address
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Address Line | 1226 ROYAL DR SW SUITE E
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City | CONYERS
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State | GA
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Zip | 30094-5925
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Country | US
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Telephone | 678-973-1560
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Fax | 706-223-6788
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Provider Business Mailing Address
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Address Line | 1226 ROYAL DR SW SUITE E
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City | CONYERS
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State | GA
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Zip | 30094-5925
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Country | US
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Telephone | 678-973-1560
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Fax | 706-223-6788
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 760
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number | 0
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License Number State | GA
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