Provider Demographics
NPI:1235264532
Name:STAHEL, DOUGLAS J (LCSW)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:J
Last Name:STAHEL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 ROSWELL RD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-3811
Mailing Address - Country:US
Mailing Address - Phone:678-252-6115
Mailing Address - Fax:678-399-1678
Practice Address - Street 1:2050 ROSWELL RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-3811
Practice Address - Country:US
Practice Address - Phone:678-252-6115
Practice Address - Fax:678-399-1678
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000554104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00671811AMedicaid
GA80BBDGHMedicare ID - Type Unspecified