Provider Demographics
NPI:1790083079
Name:STILLPOINTATLANTA, LLC
Entity Type:Organization
Organization Name:STILLPOINTATLANTA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LELA
Authorized Official - Middle Name:CAMP
Authorized Official - Last Name:BALBONI
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:404-467-8643
Mailing Address - Street 1:2950 MOUNT WILKINSON PKWY SE
Mailing Address - Street 2:UNIT 908
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3637
Mailing Address - Country:US
Mailing Address - Phone:404-467-8643
Mailing Address - Fax:404-812-3101
Practice Address - Street 1:1790 LAVISTA RD NE
Practice Address - Street 2:C/O EMMANUAL CENTER
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-3604
Practice Address - Country:US
Practice Address - Phone:404-467-8643
Practice Address - Fax:404-812-3101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005764101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty