MEDICARE: MRS. STEPHANIE ELIZABETH WIESMAN MS, LMHC, 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	101YM0800X	Mental Health Counselor	APC004196	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417331927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STEPHANIE ELIZABETH WIESMAN MS, LMHC, LPC

Provider Business Mailing Address
First Line	:	4024 ORCHARD HILL TER
Second Line	:
City	:	STONE MOUNTAIN
State	:	GA
Zip	:	30083-1249
Country	:	US
Telephone Number	:	404-387-2689
Fax Number	:

Provider Business Practice Location Address
First Line	:	1505 LILBURN STONE MOUNTAIN RD
Second Line	:	SUITE 235
City	:	STONE MOUNTAIN
State	:	GA
Zip	:	30087-1857
Country	:	US
Telephone Number	:	404-387-2689
Fax Number	:

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

Provider Enumeration Date	:	07/14/2015
Last Update Date	:	12/12/2019

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