Healthcare Provider Details

I. General information

NPI: 1831763127
Provider Name (Legal Business Name): JESSE MAE STONE ED., S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2021
Last Update Date: 05/19/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7920 FAYETTEVILLE RD
FAIRBURN GA
30213-2973
US

IV. Provider business mailing address

7920 FAYETTEVILLE RD
FAIRBURN GA
30213-2973
US

V. Phone/Fax

Practice location:
  • Phone: 404-918-8381
  • Fax:
Mailing address:
  • Phone: 404-918-8381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number358633
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number358633
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number358633
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number358633
License Number StateGA
# 5
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number358633
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: