MEDICARE: STEPHANIE LAURA SHOAP CADC-T

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	056949915	GA

General Provider Information

NPI Number	:	1598618605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE LAURA SHOAP CADC-T

Provider Business Mailing Address
First Line	:	401 CREEKSTONE RDG
Second Line	:
City	:	WOODSTOCK
State	:	GA
Zip	:	30188-3746
Country	:	US
Telephone Number	:	470-230-8223
Fax Number	:	404-991-3506

Provider Business Practice Location Address
First Line	:	401 CREEKSTONE RDG
Second Line	:
City	:	WOODSTOCK
State	:	GA
Zip	:	30188-3746
Country	:	US
Telephone Number	:	470-230-8223
Fax Number	:	404-991-3506

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

Provider Enumeration Date	:	02/18/2026
Last Update Date	:	02/18/2026

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