Healthcare Provider Details

I. General information

NPI: 1063685048
Provider Name (Legal Business Name): STACE W HUFF LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2008
Last Update Date: 04/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1830 WATER PL SE SUITE 200
ATLANTA GA
30339-7407
US

IV. Provider business mailing address

1830 WATER PL SE SUITE 200
ATLANTA GA
30339-7407
US

V. Phone/Fax

Practice location:
  • Phone: 770-916-9031
  • Fax: 770-916-9030
Mailing address:
  • Phone: 770-916-9031
  • Fax: 770-916-9030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC004268
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: