Provider Demographics
NPI:1710398805
Name:ASH, CHAWANIS JEFFERSON (MDIV, CADCII, ICADC)
Entity Type:Individual
Prefix:
First Name:CHAWANIS
Middle Name:JEFFERSON
Last Name:ASH
Suffix:
Gender:F
Credentials:MDIV, CADCII, ICADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1226 ROYAL DR SW
Mailing Address - Street 2:SUITE E
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-5925
Mailing Address - Country:US
Mailing Address - Phone:678-973-1560
Mailing Address - Fax:706-223-6788
Practice Address - Street 1:1226 ROYAL DR SW
Practice Address - Street 2:SUITE E
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-5925
Practice Address - Country:US
Practice Address - Phone:678-973-1560
Practice Address - Fax:706-223-6788
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-12
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA760101YA0400X
GA0101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral