Provider Demographics
NPI:1619422789
Name:STANDISH, JONATHAN (MS, LPC, CST)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:STANDISH
Suffix:
Gender:M
Credentials:MS, LPC, CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BALTIMORE PL NW STE 260
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2116
Mailing Address - Country:US
Mailing Address - Phone:678-337-8562
Mailing Address - Fax:
Practice Address - Street 1:1 BALTIMORE PL NW STE 260
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2116
Practice Address - Country:US
Practice Address - Phone:678-337-8562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-18
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC011091101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional