Provider Demographics
NPI:1932934916
Name:PLATA, ALEX GERARDO (MS,LPC,NCC)
Entity type:Individual
Prefix:MR
First Name:ALEX
Middle Name:GERARDO
Last Name:PLATA
Suffix:
Gender:M
Credentials:MS,LPC,NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 ALTA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31907-3205
Mailing Address - Country:US
Mailing Address - Phone:706-577-7966
Mailing Address - Fax:
Practice Address - Street 1:1509 ALTA VISTA DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31907-3205
Practice Address - Country:US
Practice Address - Phone:706-577-7966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-07
Last Update Date:2024-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC014620101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional