Healthcare Provider Details

I. General information

NPI: 1821437005
Provider Name (Legal Business Name): STEPHANIE BUTCHER MEZEI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: STEPHANIE LAUREN BUTCHER LCSW

II. Dates (important events)

Enumeration Date: 06/20/2013
Last Update Date: 03/31/2022
Certification Date: 03/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 WENTWORTH CT
FAYETTEVILLE GA
30215-7830
US

IV. Provider business mailing address

520 WENTWORTH CT
FAYETTEVILLE GA
30215-7830
US

V. Phone/Fax

Practice location:
  • Phone: 770-744-3772
  • Fax:
Mailing address:
  • Phone: 770-744-3772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC011264
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW13366CP
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW007096
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: