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General NPI Number Information
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NPI Number | 1831865674
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Entity Type | Organization
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Legal Business Name | CHANTE WELLINGTON MITCHELL, PH.D., LLC
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Dates
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Enumeration Date | 08/20/2021
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Last Update Date | 08/20/2021
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Provider Practice Location Address
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Address Line | 2400 PLEASANT HILL RD STE 165
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City | DULUTH
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State | GA
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Zip | 30096-1702
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Country | US
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Telephone | 770-476-1967
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Fax | 770-476-0377
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Provider Business Mailing Address
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Address Line | 2400 PLEASANT HILL RD STE 165
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City | DULUTH
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State | GA
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Zip | 30096-1702
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Country | US
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Telephone | 770-476-1967
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Fax | 770-476-0377
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | DR. CHANTE WELLINGTON MITCHELL
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Credential | PH.D.
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Telephone | 770-476-0377
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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