Provider Demographics
NPI:1326136508
Name:BISHOP-COLLUM, STEPHANIE LEIGH (LCSW)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:LEIGH
Last Name:BISHOP-COLLUM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1401 APPLEWOOD DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-2699
Mailing Address - Country:US
Mailing Address - Phone:706-270-5002
Mailing Address - Fax:706-270-5111
Practice Address - Street 1:180 WATER OAK DR
Practice Address - Street 2:
Practice Address - City:CEDARTOWN
Practice Address - State:GA
Practice Address - Zip Code:30125-2095
Practice Address - Country:US
Practice Address - Phone:770-748-2225
Practice Address - Fax:770-749-0939
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GACSW0025371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACSW002537OtherLICENSE