Provider Demographics
NPI:1578084687
Name:BROWN, CHATELAH D (LMSW)
Entity Type:Individual
Prefix:MS
First Name:CHATELAH
Middle Name:D
Last Name:BROWN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3470 MCCLURE BRIDGE RD UNIT 1081
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-1112
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3379 AZTEC ROAD
Practice Address - Street 2:APT. 9D
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-3009
Practice Address - Country:US
Practice Address - Phone:404-808-0287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-28
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7150621041S0200X
175T00000X
GAMSW007240405300000X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No175T00000XOther Service ProvidersPeer Specialist
No405300000XOther Service ProvidersPrevention Professional