Provider Demographics
NPI:1447342225
Name:DALTON, CEREE R (CNS)
Entity type:Individual
Prefix:
First Name:CEREE
Middle Name:R
Last Name:DALTON
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4331 THURMON TANNER PARKWAY
Mailing Address - Street 2:
Mailing Address - City:FLOWERY BRANCH
Mailing Address - State:GA
Mailing Address - Zip Code:30542
Mailing Address - Country:US
Mailing Address - Phone:678-513-5700
Mailing Address - Fax:678-513-5830
Practice Address - Street 1:4331 THURMON TANNER PARKWAY
Practice Address - Street 2:
Practice Address - City:FLOWERY BRANCH
Practice Address - State:GA
Practice Address - Zip Code:30542
Practice Address - Country:US
Practice Address - Phone:678-513-5700
Practice Address - Fax:678-513-5830
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN044035 CNS/PMH101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
89BBBJGMedicare ID - Type Unspecified
Q22799Medicare UPIN