Provider Demographics
NPI:1225280043
Name:POOLE, STEFANIE S (MED, PPS)
Entity Type:Individual
Prefix:MRS
First Name:STEFANIE
Middle Name:S
Last Name:POOLE
Suffix:
Gender:F
Credentials:MED, PPS
Other - Prefix:MS
Other - First Name:STEFANIE
Other - Middle Name:S
Other - Last Name:BUTLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:147 PROMINENCE CT
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-8264
Mailing Address - Country:US
Mailing Address - Phone:951-269-9490
Mailing Address - Fax:
Practice Address - Street 1:147 PROMINENCE CT
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-8264
Practice Address - Country:US
Practice Address - Phone:951-269-9490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-13
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health