Provider Demographics
NPI:1245074152
Name:HARVEY, CHASTIDY
Entity type:Individual
Prefix:
First Name:CHASTIDY
Middle Name:
Last Name:HARVEY
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 1:800 GALLERIA PKWY SE UNIT 509
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-6008
Mailing Address - Country:US
Mailing Address - Phone:678-523-7140
Mailing Address - Fax:
Practice Address - Street 1:2451 CUMBERLAND PKWY SE STE 3152
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-6136
Practice Address - Country:US
Practice Address - Phone:786-673-8856
Practice Address - Fax:833-411-1598
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-24
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
GA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical