Provider Information for 1740641968
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KIESHA MICHELE STANLEY LPC
Sex: Female
NPI: 1740641968
Last Updated: 2024-10-21
Certification Date: 2024-10-21
Certification Date: 2024-10-21
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1740641968 | ||||||||||||
| Enumeration Date | 2016-03-15 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 3236 WARD DR SW ATLANTA, GA 30354-2625 United States Phone: 404-268-1379 | Fax: | ||||||||||||
| Primary Practice Address | 250 CORPORATE CENTER CT STOCKBRIDGE, GA 30281-6388 United States Phone: 770-389-8100 | Fax:770-389-3030 | ||||||||||||
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