Provider Demographics
NPI:1831865674
Name:CHANTE WELLINGTON MITCHELL, PH.D., LLC
Entity type:Organization
Organization Name:CHANTE WELLINGTON MITCHELL, PH.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHANTE
Authorized Official - Middle Name:WELLINGTON
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:770-476-0377
Mailing Address - Street 1:2400 PLEASANT HILL RD STE 165
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-1702
Mailing Address - Country:US
Mailing Address - Phone:770-476-1967
Mailing Address - Fax:770-476-0377
Practice Address - Street 1:2400 PLEASANT HILL RD STE 165
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-1702
Practice Address - Country:US
Practice Address - Phone:770-476-1967
Practice Address - Fax:770-476-0377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-20
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty