Provider Demographics
NPI:1295265668
Name:GEORGE, STEPHANIE LYNN (LISW)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LYNN
Last Name:GEORGE
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6264 S SUNBURY RD
Mailing Address - Street 2:STE 400
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-2972
Mailing Address - Country:US
Mailing Address - Phone:614-964-2900
Mailing Address - Fax:614-964-2901
Practice Address - Street 1:6264 S SUNBURY RD
Practice Address - Street 2:STE 400
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-2972
Practice Address - Country:US
Practice Address - Phone:614-964-2900
Practice Address - Fax:614-964-2901
Is Sole Proprietor?:No
Enumeration Date:2017-06-18
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.17004231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical