Provider Demographics
NPI:1073767174
Name:MITCHELL, CHANTE WELLINGTON (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHANTE
Middle Name:WELLINGTON
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:CHANTE
Other - Middle Name:WELLINGTON
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:2400 PLEASANT HILL RD STE 165
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-1702
Mailing Address - Country:US
Mailing Address - Phone:770-476-1967
Mailing Address - Fax:770-476-0377
Practice Address - Street 1:2400 PLEASANT HILL RD STE 165
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-1702
Practice Address - Country:US
Practice Address - Phone:412-609-7550
Practice Address - Fax:770-476-0377
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-17
Last Update Date:2021-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY004393103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty