Individual
CHARDONNAY PATTERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
3629 OCCIDENTAL CT, DECATUR, GA 30034-5502
(757) 778-0986
Mailing address
3629 OCCIDENTAL CT, DECATUR, GA 30034-5502
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
104100000X
Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42951225
—
GA
Enumeration date
04/11/2019
Last updated
04/11/2019
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