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General NPI Number Information
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NPI Number | 1659816288
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Entity Type | Individual
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Provider Name | STEPHANIE WALTHOUR LMFT
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Gender | Female
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Dates
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Enumeration Date | 01/05/2017
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Last Update Date | 07/02/2018
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Provider Practice Location Address
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Address Line | 3400 CHAPEL HILL RD STE 317
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City | DOUGLASVILLE
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State | GA
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Zip | 30135
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Country | US
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Telephone | 704-293-9875
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Fax |
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Provider Business Mailing Address
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Address Line | 5059 IRVINE DR
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-2042
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Country | US
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Telephone | 704-293-9875
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MT3245
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFT001585
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License Number State | GA
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