Provider Demographics
NPI:1851160832
Name:CALLAHAN, ALEX BENJAMIN (APC, MA)
Entity Type:Individual
Prefix:MR
First Name:ALEX
Middle Name:BENJAMIN
Last Name:CALLAHAN
Suffix:
Gender:M
Credentials:APC, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 CENTRAL PLZ
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-3230
Mailing Address - Country:US
Mailing Address - Phone:706-512-1152
Mailing Address - Fax:
Practice Address - Street 1:436 BROAD ST
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30161-3054
Practice Address - Country:US
Practice Address - Phone:678-677-3225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-01
Last Update Date:2024-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC008958101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional