Provider Demographics
NPI:1811383383
Name:CHAPMAN, KRISTIN SARAH (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:SARAH
Last Name:CHAPMAN
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4255 WADE GREEN RD NW
Mailing Address - Street 2:STE. 414
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-1762
Mailing Address - Country:US
Mailing Address - Phone:678-213-2194
Mailing Address - Fax:678-922-7767
Practice Address - Street 1:4255 WADE GREEN RD NW
Practice Address - Street 2:STE. 414
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-1762
Practice Address - Country:US
Practice Address - Phone:678-213-2194
Practice Address - Fax:678-922-7767
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-12
Last Update Date:2015-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT001297106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist