Provider Demographics
NPI:1043048085
Name:STANGA, MARK JOSHUA (LMSW, MS, BS)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:JOSHUA
Last Name:STANGA
Suffix:
Gender:M
Credentials:LMSW, MS, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 FERRY LANDING LN NW UNIT 1414
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-1672
Mailing Address - Country:US
Mailing Address - Phone:504-717-6234
Mailing Address - Fax:
Practice Address - Street 1:21 FERRY LANDING LN NW UNIT 1414
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-1672
Practice Address - Country:US
Practice Address - Phone:504-717-6234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW0084891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical