Provider Demographics
NPI:1215592118
Name:DAIRLYN CHELETTE LCSW LLC
Entity Type:Organization
Organization Name:DAIRLYN CHELETTE LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:DAIRLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHELETTE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:770-446-5642
Mailing Address - Street 1:4530 S BERKELEY LAKE RD STE B
Mailing Address - Street 2:
Mailing Address - City:BERKELEY LAKE
Mailing Address - State:GA
Mailing Address - Zip Code:30071-1657
Mailing Address - Country:US
Mailing Address - Phone:770-446-5642
Mailing Address - Fax:770-446-5643
Practice Address - Street 1:4530 S BERKELEY LAKE RD STE B
Practice Address - Street 2:
Practice Address - City:BERKELEY LAKE
Practice Address - State:GA
Practice Address - Zip Code:30071-1657
Practice Address - Country:US
Practice Address - Phone:770-446-5642
Practice Address - Fax:770-446-5643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-06
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health