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General NPI Number Information
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NPI Number | 1922829068
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Entity Type | Organization
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Legal Business Name | CHERYL COLETTA PSY D PC
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Dates
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Enumeration Date | 10/22/2024
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Last Update Date | 10/22/2024
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Provider Practice Location Address
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Address Line | 125 TOWNPARK DR NW STE 300
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City | KENNESAW
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State | GA
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Zip | 30144-3231
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Country | US
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Telephone | 561-279-5599
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Fax |
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Provider Business Mailing Address
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Address Line | 125 TOWNPARK DR NW STE 300
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City | KENNESAW
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State | GA
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Zip | 30144-3231
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Country | US
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Telephone | 561-279-5599
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. CHERYL COLETTA
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Credential | PSY.D.
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Telephone | 561-279-5599
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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