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General NPI Number Information
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NPI Number | 1104648740
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Entity Type | Individual
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Provider Name | STACI R LEVINE MSW
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Gender | Female
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Dates
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Enumeration Date | 10/25/2024
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Last Update Date | 05/02/2025
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Provider Practice Location Address
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Address Line | 1820 THE EXCHANGE SE STE 750
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City | ATLANTA
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State | GA
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Zip | 30339-2088
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Country | US
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Telephone | 678-744-8313
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Fax |
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Provider Business Mailing Address
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Address Line | 877 BIRDS ML SE
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City | MARIETTA
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State | GA
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Zip | 30067-5141
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Country | US
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Telephone | 770-596-1237
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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