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MR. STANLEY MICHAEL EUGENE ALLEN LCSW
Clinical >> Social Worker >> Behavioral Health & Social Service ProvidersRegistrant NPI Number: 1023179116
Individual Registrant:MR. STANLEY MICHAEL EUGENE ALLEN LCSW
Gender: M
Sole Proprietor
Gender: M
Sole Proprietor
Location and contact information for practice:
1770 INDIAN TRAIL RD SUITE 200 NORCROSS, GA 30093-2645 US
Tel: 770-923-9200 Fax: --
Tel: 770-923-9200 Fax: --
Contact information for business:
1499 KAY LN NE ATLANTA, GA 30306-3111 US
Tel: 404-219-5821 Fax: --
Tel: 404-219-5821 Fax: --
Registration Information:
NPI: 1023179116
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 1041C0700X | Behavioral Health & Social Service Providers Social Worker Clinical | GA | CSW000707 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| 032860193A | GA | 05 |
