Provider Demographics
NPI:1669202305
Name:GUILLORY, CHANTELL MOBLEY
Entity type:Individual
Prefix:
First Name:CHANTELL
Middle Name:MOBLEY
Last Name:GUILLORY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10910 QUEEN ANNE CT APT B
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-5576
Mailing Address - Country:US
Mailing Address - Phone:912-412-5293
Mailing Address - Fax:
Practice Address - Street 1:10910 QUEEN ANNE CT APT B
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-5576
Practice Address - Country:US
Practice Address - Phone:912-412-5293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No172A00000XOther Service ProvidersDriverGroup - Multi-Specialty