Provider Demographics
NPI:1235594045
Name:STEVENS, JANICE
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:STEVENS
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 1:9 DUNWOODY PARK
Mailing Address - Street 2:SUITE 136
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-7407
Mailing Address - Country:US
Mailing Address - Phone:404-457-6199
Mailing Address - Fax:
Practice Address - Street 1:9 DUNWOODY PARK
Practice Address - Street 2:SUITE 136
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-7407
Practice Address - Country:US
Practice Address - Phone:404-457-6199
Practice Address - Fax:470-545-4382
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-21
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003716101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor