Provider Demographics
NPI:1689242018
Name:MAKANGA, STEPHANIE WACHS
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:WACHS
Last Name:MAKANGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1960 ROLLINGWOOD DR SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30316-4424
Mailing Address - Country:US
Mailing Address - Phone:214-535-5756
Mailing Address - Fax:
Practice Address - Street 1:515 E PONCE DE LEON AVE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-1941
Practice Address - Country:US
Practice Address - Phone:770-589-0788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-13
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0070151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical