Provider Demographics
NPI:1851831390
Name:CHANNELL, JANENE
Entity type:Individual
Prefix:
First Name:JANENE
Middle Name:
Last Name:CHANNELL
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 1:3166 DELACORTE DR
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-1403
Mailing Address - Country:US
Mailing Address - Phone:770-743-2395
Mailing Address - Fax:
Practice Address - Street 1:3166 DELACORTE DR
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-1403
Practice Address - Country:US
Practice Address - Phone:770-743-2395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-02
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health