Provider Demographics
NPI:1336963719
Name:CHALLEN, KERI M
Entity type:Individual
Prefix:
First Name:KERI
Middle Name:M
Last Name:CHALLEN
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 1:1549 CLAIRMONT RD STE 203
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-4635
Mailing Address - Country:US
Mailing Address - Phone:770-430-0919
Mailing Address - Fax:
Practice Address - Street 1:1549 CLAIRMONT RD STE 203
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-4635
Practice Address - Country:US
Practice Address - Phone:770-430-0919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-12
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health