Healthcare Provider Details

I. General information

NPI: 1073423844
Provider Name (Legal Business Name): OKISTA S TORY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

367 RICHARDSON RD SE
CALHOUN GA
30701-3619
US

IV. Provider business mailing address

150 PREACHER SMITH RD SE
SILVER CREEK GA
30173-2404
US

V. Phone/Fax

Practice location:
  • Phone: 478-200-9931
  • Fax:
Mailing address:
  • Phone: 706-936-3875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: