Healthcare Provider Details

I. General information

NPI: 1518861640
Provider Name (Legal Business Name): MR. VIDAL EDWARD SANABRIA JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2026
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 HIGHTOWER TRL STE 105
SANDY SPRINGS GA
30350-2917
US

IV. Provider business mailing address

47 EVANS PT
DALLAS GA
30157-9390
US

V. Phone/Fax

Practice location:
  • Phone: 678-916-6427
  • Fax:
Mailing address:
  • Phone: 404-840-2803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC0I7095
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: