Provider Demographics
NPI:1144528787
Name:CHRISTIAN-STALLWORTH, PAULA L (LPC,CADC II,CCDP-D)
Entity type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:L
Last Name:CHRISTIAN-STALLWORTH
Suffix:
Gender:F
Credentials:LPC,CADC II,CCDP-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:343 SALEM GATE DRIVE SE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-1783
Mailing Address - Country:US
Mailing Address - Phone:770-929-1470
Mailing Address - Fax:770-929-1425
Practice Address - Street 1:343 SALEM GATE DRIVE SE
Practice Address - Street 2:SUITE 101
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-1783
Practice Address - Country:US
Practice Address - Phone:770-929-1470
Practice Address - Fax:770-929-1425
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-07
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACDP0009101Y00000X
GACADCII 497103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst