Provider Demographics
NPI:1508188095
Name:STEFANKO, AMY H (LCSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:H
Last Name:STEFANKO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:H
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11675 CENTURY DR UNIT C
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-8367
Mailing Address - Country:US
Mailing Address - Phone:770-284-3399
Mailing Address - Fax:470-299-2260
Practice Address - Street 1:11675 CENTURY DR UNIT C
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-8367
Practice Address - Country:US
Practice Address - Phone:770-284-3399
Practice Address - Fax:470-299-2260
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-24
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH07000911041C0700X
MI68010908941041C0700X
GACSW0059871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical