Provider Demographics
NPI:1376132951
Name:CHEN, DANIELLE (LMFT, RPT, ATR)
Entity type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:
Last Name:CHEN
Suffix:
Gender:F
Credentials:LMFT, RPT, ATR
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:TIDWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:986 BLUE RIDGE AVE NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-4417
Mailing Address - Country:US
Mailing Address - Phone:678-677-7484
Mailing Address - Fax:
Practice Address - Street 1:986 BLUE RIDGE AVE NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30306-4417
Practice Address - Country:US
Practice Address - Phone:470-296-3264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-18
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT001644106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1598216061OtherNPI