Provider Demographics
NPI:1790569903
Name:CRUNK, STEPHANIE LEAH (BIRTH COUNSELOR)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LEAH
Last Name:CRUNK
Suffix:
Gender:F
Credentials:BIRTH COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1539 NICKLESVILLE RD NE
Mailing Address - Street 2:
Mailing Address - City:RESACA
Mailing Address - State:GA
Mailing Address - Zip Code:30735-6425
Mailing Address - Country:US
Mailing Address - Phone:910-605-3341
Mailing Address - Fax:
Practice Address - Street 1:1539 NICKLESVILLE RD NE
Practice Address - Street 2:
Practice Address - City:RESACA
Practice Address - State:GA
Practice Address - Zip Code:30735-6425
Practice Address - Country:US
Practice Address - Phone:910-605-3341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175M00000XOther Service ProvidersMidwife, Lay
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty