Provider Demographics
NPI:1639406945
Name:STEPHENS-BILLINGSLEY, MARTALYN GRACE (MS, LPC)
Entity Type:Individual
Prefix:MRS
First Name:MARTALYN
Middle Name:GRACE
Last Name:STEPHENS-BILLINGSLEY
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 KIMBERLY LN
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30296-2000
Mailing Address - Country:US
Mailing Address - Phone:678-643-3653
Mailing Address - Fax:
Practice Address - Street 1:7000 KIMBERLY LN
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30296-2000
Practice Address - Country:US
Practice Address - Phone:678-643-3653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-06
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005528101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GALPC005528OtherPROFESSIONAL COUNSELOR NUMBER