Individual
STATISHA L PERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2300 W PARK PLACE BLVD STE 135, SUITE 135, STONE MOUNTAIN, GA 30087-3561
(678) 330-1400
Mailing address
4380 BRADLEY DR, SNELLVILLE, GA 30039-6542
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
101YM0800X
Mental Health Counselor
—
—
Other
Enumeration date
12/03/2018
Last updated
12/03/2018
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