Provider Demographics
NPI:1497982599
Name:RIETTA, DANIELLE CHAMBERS
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:CHAMBERS
Last Name:RIETTA
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 1:2450 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-3029
Mailing Address - Country:US
Mailing Address - Phone:678-977-1643
Mailing Address - Fax:
Practice Address - Street 1:5805 STATE BRIDGE RD STE G158
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-8220
Practice Address - Country:US
Practice Address - Phone:678-977-1643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-16
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC010757101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional