Provider Demographics
NPI:1568794584
Name:ELLIOTT, STEPHANIE ELIZABETH (LGSW)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ELIZABETH
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:ELIZABETH
Other - Last Name:GLENN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1061 HARMON AVE
Mailing Address - Street 2:STE 1D03 WINN ARMY COMMUNITY HOSPITAL
Mailing Address - City:FORT STEWART
Mailing Address - State:GA
Mailing Address - Zip Code:31314-5641
Mailing Address - Country:US
Mailing Address - Phone:912-767-7301
Mailing Address - Fax:
Practice Address - Street 1:1061 HARMON AVE
Practice Address - Street 2:STE 1D03 WINN ARMY COMMUNITY HOSPITAL
Practice Address - City:FORT STEWART
Practice Address - State:GA
Practice Address - Zip Code:31314-5641
Practice Address - Country:US
Practice Address - Phone:912-767-7301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-01
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDG13145104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker