Provider Demographics
NPI:1639454887
Name:SPEANBURG, STEFANIE L (LCSW)
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:L
Last Name:SPEANBURG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 SPRING ST NW
Mailing Address - Street 2:SUITE 225
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309
Mailing Address - Country:US
Mailing Address - Phone:404-556-2878
Mailing Address - Fax:
Practice Address - Street 1:1350 SPRING ST NW
Practice Address - Street 2:SUITE 225
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-2864
Practice Address - Country:US
Practice Address - Phone:404-556-2878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0045411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical