Healthcare Provider Details

I. General information

NPI: 1376498154
Provider Name (Legal Business Name): ANASTASIA CHRYSOSTOM MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2026
Last Update Date: 02/26/2026
Certification Date: 02/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4720 PEACHTREE INDUSTRIAL BLVD STE 4101
BERKELEY LAKE GA
30071-5737
US

IV. Provider business mailing address

4720 PEACHTREE INDUSTRIAL BLVD STE 4101
BERKELEY LAKE GA
30071-5737
US

V. Phone/Fax

Practice location:
  • Phone: 678-992-5972
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: