Provider Demographics
NPI:1376908046
Name:CHASTAIN, ARDIN PARKER LINGLE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ARDIN
Middle Name:PARKER LINGLE
Last Name:CHASTAIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ARDIN
Other - Middle Name:
Other - Last Name:BAUGHMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:568 WESTWOODS DR
Mailing Address - Street 2:
Mailing Address - City:ELLIJAY
Mailing Address - State:GA
Mailing Address - Zip Code:30540-3040
Mailing Address - Country:US
Mailing Address - Phone:770-377-2084
Mailing Address - Fax:
Practice Address - Street 1:142 RIVER TER
Practice Address - Street 2:
Practice Address - City:ELLIJAY
Practice Address - State:GA
Practice Address - Zip Code:30540-5549
Practice Address - Country:US
Practice Address - Phone:770-377-2084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-23
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0081051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical