Provider Demographics
NPI:1720715865
Name:CHUPP, ANNA CHARLOTTE
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:CHARLOTTE
Last Name:CHUPP
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 1:122 W FORSYTH ST
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-3561
Mailing Address - Country:US
Mailing Address - Phone:229-815-5454
Mailing Address - Fax:
Practice Address - Street 1:410 E CHURCH ST
Practice Address - Street 2:
Practice Address - City:FORT VALLEY
Practice Address - State:GA
Practice Address - Zip Code:31030-3097
Practice Address - Country:US
Practice Address - Phone:229-815-5454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor