Healthcare Provider Details

I. General information

NPI: 1356708234
Provider Name (Legal Business Name): STEPHANIE FICKLE MA, LAPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2016
Last Update Date: 01/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 ATLANTA HWY SUITE 1901
CUMMING GA
30040-8099
US

IV. Provider business mailing address

207 WOODVIEW LN
WOODSTOCK GA
30188-6074
US

V. Phone/Fax

Practice location:
  • Phone: 770-744-1324
  • Fax: 678-456-8573
Mailing address:
  • Phone: 404-455-0185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPC005075
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: