Provider Demographics
NPI:1073214409
Name:STEVENSON, STEFANIE MESHAL
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:MESHAL
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2224 ARBOR FOREST TRL SW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-2857
Mailing Address - Country:US
Mailing Address - Phone:214-497-1995
Mailing Address - Fax:
Practice Address - Street 1:259 WOODCREEK WAY
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-2006
Practice Address - Country:US
Practice Address - Phone:214-497-1995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician