Provider Demographics
NPI:1356774061
Name:COLETTA, CHERYL NANCY (PSYD)
Entity type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:NANCY
Last Name:COLETTA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 TOWNPARK DR NW STE 300
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-3231
Mailing Address - Country:US
Mailing Address - Phone:561-279-5599
Mailing Address - Fax:888-974-3548
Practice Address - Street 1:125 TOWNPARK DR NW STE 300
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-3231
Practice Address - Country:US
Practice Address - Phone:561-279-5599
Practice Address - Fax:888-974-3548
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-16
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 8588103T00000X
GAPSY004582103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist