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NPI Code Detail

MEDICARE: STACI STEPHENS

MEDICARE: STACI STEPHENS
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
1101YP2500XProfessional CounselorAPC003632GA

General Provider Information

NPI Number : 1891174900
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACI STEPHENS
Provider Business Mailing Address
First Line : 5090 MINERS CREEK CIR
Second Line :
City : LITHONIA
State : GA
Zip : 30038-3809
Country : US
Telephone Number : 770-981-8711
Fax Number :
Provider Business Practice Location Address
First Line : 1944 BRANNAN RD
Second Line :
City : MCDONOUGH
State : GA
Zip : 30253-4310
Country : US
Telephone Number : 678-289-6981
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/21/2015
Last Update Date : 01/20/2016

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Directions to “ STACI STEPHENS ” Practice Location

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