Provider Demographics
NPI:1619563202
Name:MINOR, SIDNEY ALEXANDRIA (MS, LPC, NCC)
Entity Type:Individual
Prefix:MS
First Name:SIDNEY
Middle Name:ALEXANDRIA
Last Name:MINOR
Suffix:
Gender:F
Credentials:MS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 TRINITY AVE SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303-3626
Mailing Address - Country:US
Mailing Address - Phone:404-802-3500
Mailing Address - Fax:
Practice Address - Street 1:130 TRINITY AVE SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-3626
Practice Address - Country:US
Practice Address - Phone:404-802-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-17
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106E00000X, 101YM0800X
GALPC014479101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health