Provider Demographics
NPI:1316178049
Name:PILGRIM, CHANDA LYNNE (PHD)
Entity type:Individual
Prefix:DR
First Name:CHANDA
Middle Name:LYNNE
Last Name:PILGRIM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:945 N INDIAN CREEK DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:GA
Mailing Address - Zip Code:30021-2221
Mailing Address - Country:US
Mailing Address - Phone:718-704-6901
Mailing Address - Fax:404-298-0046
Practice Address - Street 1:945 N INDIAN CREEK DR
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:GA
Practice Address - Zip Code:30021-2221
Practice Address - Country:US
Practice Address - Phone:404-298-9005
Practice Address - Fax:404-298-0046
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-29
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003471103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist