Provider Demographics
NPI:1649910498
Name:STANLEY, DAVID L (LPC)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:L
Last Name:STANLEY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 COLLINS CT
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31216-5462
Mailing Address - Country:US
Mailing Address - Phone:478-714-7052
Mailing Address - Fax:
Practice Address - Street 1:102 COLLINS CT
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31216-5462
Practice Address - Country:US
Practice Address - Phone:478-714-7052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA010159101YP2500X
GA101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional