MEDICARE: STEFANIE NICOLE MARTIN LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LPC013561	GA

General Provider Information

NPI Number	:	1235883646
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEFANIE NICOLE MARTIN LPC

Provider Business Mailing Address
First Line	:	1021 WESLEYAN CIR
Second Line	:
City	:	EVANS
State	:	GA
Zip	:	30809-0227
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3614 J DEWEY GRAY CIR STE B
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30909-6512
Country	:	US
Telephone Number	:	706-364-3470
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2022
Last Update Date	:	03/16/2026

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