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Stacy Jaynes Anderson, M.ED., LPC

Individual provider Active NPI Mental Health Counselor · Douglasville, GA

NPI 1528029089 · NPPES record last updated Jul 13, 2026

Key facts

NPI
1528029089
Entity type
Individual (NPI type 1)
Primary specialty
Mental Health Counselor 101YM0800X
License
LPC004243 (GA)
Practice address
6130 Prestley Mill Rd
Suite a
Douglasville, GA 30134-2288
Phone
(770) 949-9675
Fax
(770) 949-9676
NPI assigned
Mar 31, 2006
Sex
Female
Sole proprietor
No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No
Credentials
Master of Education

State licenses

LicenseStateTypeSpecialty
LPC004243GAMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Dennis L. Herendeen, PH.D., P.C. Past Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X LPC004243 GA Yes

Addresses

Primary practice location

6130 Prestley Mill Rd
Suite a
Douglasville, GA 30134-2288

Mailing address

6130 Prestley Mill Rd
Suite a
Douglasville, GA 30134-2288
Phone (770) 949-9675

Other providers in Douglasville, GA

All providers in Douglasville, GA · Mental Health Counselor in Georgia

Sources for this page

Verify at the official NPI Registry.