Provider Demographics
NPI:1093504078
Name:STANTON, CHARITY DANAE
Entity type:Individual
Prefix:
First Name:CHARITY
Middle Name:DANAE
Last Name:STANTON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4632 BROWNS MILL LN
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-4673
Mailing Address - Country:US
Mailing Address - Phone:678-789-9313
Mailing Address - Fax:
Practice Address - Street 1:2375 WALL ST SE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-6702
Practice Address - Country:US
Practice Address - Phone:470-829-6301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health