MEDICARE: DEVON'S PLACE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1467807198	OTHER	GA	LCSW
2	1104296052	OTHER	GA	LCSW

General Provider Information

NPI Number	:	1427888536
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEVON'S PLACE

Provider Business Mailing Address
First Line	:	41 LENOX POINTE NE STE B
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30324-7424
Country	:	US
Telephone Number	:	678-597-8084
Fax Number	:

Provider Business Practice Location Address
First Line	:	41 LENOX POINTE NE STE B
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30324-7424
Country	:	US
Telephone Number	:	678-597-8084
Fax Number	:

Authorized Official
Title or Position	:	CO-OWNER
Name	:	JAIME ANN STEPANSKY
Credential	:	LCSW, RPT
Telephone Number	:	678-561-5831

Provider Enumeration Date	:	08/05/2024
Last Update Date	:	01/21/2025

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Directions to “DEVON'S PLACE ” Practice Location

Language	Start Address	Practice Location

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