Provider Demographics
NPI:1275250318
Name:CHARLES, JOANNE KRIS (MA)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:KRIS
Last Name:CHARLES
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 CRESCENT WOODE DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30157-5724
Mailing Address - Country:US
Mailing Address - Phone:470-422-9731
Mailing Address - Fax:
Practice Address - Street 1:3232 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-3419
Practice Address - Country:US
Practice Address - Phone:470-422-9731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-19
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health