Provider Demographics
NPI:1184222341
Name:TSHIALA, CHANTALE (MS)
Entity Type:Individual
Prefix:MS
First Name:CHANTALE
Middle Name:
Last Name:TSHIALA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4188 ALDEN PARK DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30035-1400
Mailing Address - Country:US
Mailing Address - Phone:240-353-2164
Mailing Address - Fax:
Practice Address - Street 1:50 GLENLAKE PKWY STE 120
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-7270
Practice Address - Country:US
Practice Address - Phone:678-328-4102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-11
Last Update Date:2020-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty