Provider Demographics
NPI:1083960132
Name:DANN, STEPHANIE RENEE (LAC, DIPLAC)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:RENEE
Last Name:DANN
Suffix:
Gender:F
Credentials:LAC, DIPLAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 STEWART LN
Mailing Address - Street 2:
Mailing Address - City:CLARKESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30523-5519
Mailing Address - Country:US
Mailing Address - Phone:864-710-4315
Mailing Address - Fax:
Practice Address - Street 1:307 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-2725
Practice Address - Country:US
Practice Address - Phone:864-710-4315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-26
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCACUP158171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist