Provider Demographics
NPI:1740641968
Name:STANLEY, KIESHA MICHELE (LPC)
Entity type:Individual
Prefix:
First Name:KIESHA
Middle Name:MICHELE
Last Name:STANLEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3236 WARD DR SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30354-2625
Mailing Address - Country:US
Mailing Address - Phone:404-268-1379
Mailing Address - Fax:
Practice Address - Street 1:250 CORPORATE CENTER CT
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-6388
Practice Address - Country:US
Practice Address - Phone:770-389-8100
Practice Address - Fax:770-389-3030
Is Sole Proprietor?:No
Enumeration Date:2016-03-15
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC004821101YP2500X
GALPC009900101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional