Healthcare Provider Details

I. General information

NPI: 1942979489
Provider Name (Legal Business Name): ALASIA CLINTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2021
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

913 MAIN ST STE C
STONE MOUNTAIN GA
30083-3096
US

IV. Provider business mailing address

950 LAKE RIDGE PKWY APT 10003
RIVERDALE GA
30296-7156
US

V. Phone/Fax

Practice location:
  • Phone: 770-728-3990
  • Fax:
Mailing address:
  • Phone: 205-470-2299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMSW013161
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: