Provider Demographics
NPI:1306200605
Name:CULBREATH, NICOLETTE CHAIN (MA, LPC)
Entity Type:Individual
Prefix:
First Name:NICOLETTE
Middle Name:CHAIN
Last Name:CULBREATH
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2420 WOOD MEADOWS DR SW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-4471
Mailing Address - Country:US
Mailing Address - Phone:678-933-6526
Mailing Address - Fax:
Practice Address - Street 1:2420 WOOD MEADOWS DR SW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-4471
Practice Address - Country:US
Practice Address - Phone:678-933-6526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-12
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008852101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional