Provider Demographics
NPI:1821437005
Name:MEZEI, STEPHANIE BUTCHER (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:BUTCHER
Last Name:MEZEI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:LAUREN
Other - Last Name:BUTCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:520 WENTWORTH CT
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30215-7830
Mailing Address - Country:US
Mailing Address - Phone:770-744-3772
Mailing Address - Fax:
Practice Address - Street 1:520 WENTWORTH CT
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30215-7830
Practice Address - Country:US
Practice Address - Phone:770-744-3772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-20
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0112641041C0700X
SCSW13366CP1041C0700X
GACSW0070961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical