Provider Demographics
NPI:1023717998
Name:CLEMMONS, CHEZ (LPC013537)
Entity type:Individual
Prefix:MS
First Name:CHEZ
Middle Name:
Last Name:CLEMMONS
Suffix:
Gender:F
Credentials:LPC013537
Other - Prefix:MS
Other - First Name:CHEZ
Other - Middle Name:PARKER
Other - Last Name:CLEMMONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CHEZ PARKER
Mailing Address - Street 1:7066 SILVER BEND OVERLOOK
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30168-7462
Mailing Address - Country:US
Mailing Address - Phone:770-605-8745
Mailing Address - Fax:
Practice Address - Street 1:7066 SILVER BEND OVERLOOK
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30168-7462
Practice Address - Country:US
Practice Address - Phone:770-605-8745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC013537101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GALPC013537OtherLICENSE FOR PROFESSIONAL COUNSELING