Provider Demographics
NPI:1851093306
Name:KELLER, TAMMY THOMPSON (MA, CADC-II)
Entity Type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:THOMPSON
Last Name:KELLER
Suffix:
Gender:F
Credentials:MA, CADC-II
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4191 PLEASANT HILL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-1411
Mailing Address - Country:US
Mailing Address - Phone:470-704-5010
Mailing Address - Fax:470-704-5011
Practice Address - Street 1:4191 PLEASANT HILL RD STE 100
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-1411
Practice Address - Country:US
Practice Address - Phone:470-704-5010
Practice Address - Fax:470-704-5011
Is Sole Proprietor?:No
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA01694101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)