Provider Demographics
NPI:1417406083
Name:HEATH, STEPHANIE BILLINGSLEY (LMFT)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:BILLINGSLEY
Last Name:HEATH
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13395
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31208-3395
Mailing Address - Country:US
Mailing Address - Phone:478-731-9516
Mailing Address - Fax:877-863-5638
Practice Address - Street 1:584 ARLINGTON PL
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-1705
Practice Address - Country:US
Practice Address - Phone:478-731-9516
Practice Address - Fax:877-863-5638
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-23
Last Update Date:2017-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT000936106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist