Individual
MR. STANLEY MICHAEL EUGENE ALLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
1770 INDIAN TRAIL RD, SUITE 200, NORCROSS, GA 30093-2645
(770) 923-9200
Mailing address
1499 KAY LN NE, ATLANTA, GA 30306-3111
(404) 219-5821
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CSW000707
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
032860193A
—
GA
Enumeration date
12/12/2006
Last updated
01/11/2012
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