Provider Demographics
NPI:1851953178
Name:SANON, STEFANIE
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:
Last Name:SANON
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 1:3800 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31907-5609
Mailing Address - Country:US
Mailing Address - Phone:800-676-5130
Mailing Address - Fax:888-959-5753
Practice Address - Street 1:3800 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31907-5609
Practice Address - Country:US
Practice Address - Phone:800-676-5130
Practice Address - Fax:888-959-5753
Is Sole Proprietor?:No
Enumeration Date:2019-07-08
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
RBT-19-91375OtherBEHAVIORAL THERAPY