Healthcare Provider Details

I. General information

NPI: 1801720206
Provider Name (Legal Business Name): STE'LA SONG JAMES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SONG JAMES

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 MEDFORD DR
FAYETTEVILLE GA
30215-1949
US

IV. Provider business mailing address

235 MEDFORD DR
FAYETTEVILLE GA
30215-1949
US

V. Phone/Fax

Practice location:
  • Phone: 770-905-1546
  • Fax:
Mailing address:
  • Phone: 770-905-1546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: