Individual
ASHLEY T STATEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4893 MEMORIAL DR, STONE MOUNTAIN, GA 30083-4175
(404) 581-2188
Mailing address
4893 MEMORIAL DR, STONE MOUNTAIN, GA 30083-4175
(404) 581-2188
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
05077957
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CN0030029971
CNA
GA
Enumeration date
10/22/2018
Last updated
10/22/2018
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