Provider Demographics
NPI:1861717985
Name:THE LISTENING EAR
Entity type:Organization
Organization Name:THE LISTENING EAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHRISTIAN-STALLWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:LPC,CADC-II,CCDP-D
Authorized Official - Phone:770-929-1470
Mailing Address - Street 1:343 SALEM GATE DR SE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-1773
Mailing Address - Country:US
Mailing Address - Phone:770-929-1470
Mailing Address - Fax:770-929-1425
Practice Address - Street 1:343 SALEM GATE DR SE
Practice Address - Street 2:SUITE 101
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-1773
Practice Address - Country:US
Practice Address - Phone:770-929-1470
Practice Address - Fax:770-929-1425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-31
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA67146251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1861717985Medicare NSC