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NPI Code Detail

MEDICARE: TAKIEYRA JASHAI STEVENS

MEDICARE: TAKIEYRA JASHAI STEVENS
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
1103TB0200XCognitive & Behavioral Psychologist
2101Y00000XCounselor

General Provider Information

NPI Number : 1790143337
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAKIEYRA JASHAI STEVENS
Provider Business Mailing Address
First Line : 227 SANDY SPRINGS PL STE D270
Second Line :
City : ATLANTA
State : GA
Zip : 30328-5918
Country : US
Telephone Number : 404-390-4098
Fax Number : 877-427-2724
Provider Business Practice Location Address
First Line : 5887 GLENRIDGE DR STE 230
Second Line :
City : ATLANTA
State : GA
Zip : 30328-9929
Country : US
Telephone Number : 404-390-4098
Fax Number : 877-427-2724
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/09/2016
Last Update Date : 05/05/2023

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