Provider Demographics
NPI:1073335725
Name:CHANEY, CIERRA NICOLE (MS, LPC)
Entity type:Individual
Prefix:
First Name:CIERRA
Middle Name:NICOLE
Last Name:CHANEY
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 VILLA VIEW WAY
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:GA
Mailing Address - Zip Code:30228-3623
Mailing Address - Country:US
Mailing Address - Phone:770-624-6494
Mailing Address - Fax:
Practice Address - Street 1:2538 STONE RD
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-5647
Practice Address - Country:US
Practice Address - Phone:404-635-6021
Practice Address - Fax:404-487-5880
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC015176101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional