Healthcare Provider Details

I. General information

NPI: 1619563202
Provider Name (Legal Business Name): SIDNEY ALEXANDRIA MINOR MS, LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2020
Last Update Date: 04/04/2024
Certification Date: 04/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 TRINITY AVE SW
ATLANTA GA
30303-3626
US

IV. Provider business mailing address

130 TRINITY AVE SW
ATLANTA GA
30303-3626
US

V. Phone/Fax

Practice location:
  • Phone: 404-802-3500
  • Fax:
Mailing address:
  • Phone: 404-802-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC014479
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: