Provider Demographics
NPI:1477130052
Name:CHIPMAN, TRISTIN JONINA
Entity Type:Individual
Prefix:
First Name:TRISTIN
Middle Name:JONINA
Last Name:CHIPMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 INMAN DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-3831
Mailing Address - Country:US
Mailing Address - Phone:404-354-5608
Mailing Address - Fax:
Practice Address - Street 1:809 CHURCH ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-1870
Practice Address - Country:US
Practice Address - Phone:404-998-0838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-28
Last Update Date:2021-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0074261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical