MEDICARE: TASHARA STANLEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LPC014682	GA

General Provider Information

NPI Number	:	1215785043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TASHARA STANLEY

Provider Business Mailing Address
First Line	:	3096 TSUE LN
Second Line	:
City	:	KAILUA
State	:	HI
Zip	:	96734-4952
Country	:	US
Telephone Number	:	210-643-1088
Fax Number	:

Provider Business Practice Location Address
First Line	:	2920 MACON RD
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31906-2204
Country	:	US
Telephone Number	:	706-507-3141
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/07/2024
Last Update Date	:	05/07/2024

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Directions to “ TASHARA STANLEY ” Practice Location

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