Individual
KESHIA STANLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1155 PERIMETER CTR, ATLANTA, GA 30338-5463
(855) 493-5523
Mailing address
4032 SHADED OASIS LN, VILLA RICA, GA 30180-6966
(256) 426-7690
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CSW005993
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14931025
CAQH
GA
Enumeration date
08/05/2020
Last updated
08/05/2020
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