Healthcare Provider Details

I. General information

NPI: 1508784463
Provider Name (Legal Business Name): STALLWORTH SYNC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2853 CANDLER RD SIDE #370061
DECATUR GA
30037-5202
US

IV. Provider business mailing address

PO BOX 370061
DECATUR GA
30037-0061
US

V. Phone/Fax

Practice location:
  • Phone: 404-493-0526
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. LADONNA CATHERINE STALLWORTH
Title or Position: OWNER/THERAPIST
Credential: LPC, LPCC, CPCS
Phone: 404-493-0526