Provider Demographics
NPI:1528656253
Name:CHILDERS, SHANTAL M (MS CADC II)
Entity type:Individual
Prefix:
First Name:SHANTAL
Middle Name:M
Last Name:CHILDERS
Suffix:
Gender:F
Credentials:MS CADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 CLOVER POINT CIR
Mailing Address - Street 2:
Mailing Address - City:GUYTON
Mailing Address - State:GA
Mailing Address - Zip Code:31312-7134
Mailing Address - Country:US
Mailing Address - Phone:912-675-3421
Mailing Address - Fax:
Practice Address - Street 1:221 EXECUTIVE CIRCLE
Practice Address - Street 2:SUITE 7
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-4529
Practice Address - Country:US
Practice Address - Phone:912-521-4301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-07
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA124764OtherDRUG AND ALCOHOL