Provider Demographics
NPI:1538743026
Name:STONE, BENJAMIN MATTHIAS (MS, LPC, BCBA)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:MATTHIAS
Last Name:STONE
Suffix:
Gender:M
Credentials:MS, LPC, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3756 LAVISTA RD
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-5614
Mailing Address - Country:US
Mailing Address - Phone:678-617-0871
Mailing Address - Fax:
Practice Address - Street 1:3760 LAVISTA RD
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-5615
Practice Address - Country:US
Practice Address - Phone:678-626-0557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-10
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC013227101YM0800X
GA1-23-67146103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health