Provider Demographics
NPI:1457622912
Name:CHALON, JENNIFER CHAPMAN (LPC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CHAPMAN
Last Name:CHALON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1087 PINEKNOT RD
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:GA
Mailing Address - Zip Code:31714-3405
Mailing Address - Country:US
Mailing Address - Phone:229-848-5404
Mailing Address - Fax:
Practice Address - Street 1:1087 PINEKNOT RD
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:GA
Practice Address - Zip Code:31714-3405
Practice Address - Country:US
Practice Address - Phone:229-848-5404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-15
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004263101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003166972AMedicaid