Provider Demographics
NPI:1144942814
Name:HERROD, CHAUNTEL (NBHWC)
Entity type:Individual
Prefix:
First Name:CHAUNTEL
Middle Name:
Last Name:HERROD
Suffix:
Gender:F
Credentials:NBHWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3290 COBB GALLERIA PKWY UNIT 15191
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-5984
Mailing Address - Country:US
Mailing Address - Phone:404-563-1666
Mailing Address - Fax:
Practice Address - Street 1:325 N SAINT PAUL ST STE 3100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-3923
Practice Address - Country:US
Practice Address - Phone:646-389-3451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach