Provider Demographics
NPI:1629836598
Name:CHAPMAN, TERA ELIZABETH
Entity Type:Individual
Prefix:
First Name:TERA
Middle Name:ELIZABETH
Last Name:CHAPMAN
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 1:3467 SANDY BANK DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30011-4679
Mailing Address - Country:US
Mailing Address - Phone:470-422-0482
Mailing Address - Fax:
Practice Address - Street 1:3467 SANDY BANK DR
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:GA
Practice Address - Zip Code:30011-4679
Practice Address - Country:US
Practice Address - Phone:470-422-0482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X, 171400000X
GA171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst