Healthcare Provider Details

I. General information

NPI: 1356053466
Provider Name (Legal Business Name): ALEXANDRIA STANTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2022
Last Update Date: 12/20/2022
Certification Date: 12/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 FAYETTEVILLE RD SE
ATLANTA GA
30316-2921
US

IV. Provider business mailing address

210 PETERS ST SW UNIT 2106
ATLANTA GA
30313-2159
US

V. Phone/Fax

Practice location:
  • Phone: 404-486-9034
  • Fax:
Mailing address:
  • Phone: 662-934-7625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: