Provider Demographics
NPI:1356025795
Name:STOUFFER, JESSICA (MSW, LMSW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:STOUFFER
Suffix:
Gender:F
Credentials:MSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 DOWNING CREEK TRL
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-6586
Mailing Address - Country:US
Mailing Address - Phone:470-270-6597
Mailing Address - Fax:
Practice Address - Street 1:303 DOWNING CREEK TRL
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-6586
Practice Address - Country:US
Practice Address - Phone:470-270-6597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW010538104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker