Provider Demographics
NPI:1841217544
Name:SPELSBERG, STEPHANIE HEMENWAY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:HEMENWAY
Last Name:SPELSBERG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1401 APPLEWOOD DR
Mailing Address - Street 2:STE 1
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-2699
Mailing Address - Country:US
Mailing Address - Phone:706-270-5003
Mailing Address - Fax:706-270-5111
Practice Address - Street 1:191 LAMAR HALEY PKWY
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-2699
Practice Address - Country:US
Practice Address - Phone:770-704-1600
Practice Address - Fax:770-704-1610
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW83281041C0700X
GACSW0037221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL767799500Medicaid
FL767799500Medicaid