Provider Demographics
NPI:1720515042
Name:SALINAS, STEPHANIE L (PSYD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:L
Last Name:SALINAS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3939 ROSWELL RD STE 200
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-6285
Mailing Address - Country:US
Mailing Address - Phone:470-956-3940
Mailing Address - Fax:
Practice Address - Street 1:3939 ROSWELL RD STE 200
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-6285
Practice Address - Country:US
Practice Address - Phone:470-956-3940
Practice Address - Fax:770-565-1830
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-17
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103G00000X, 390200000X
MO2019010428103TC0700X
GAPSY004395103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program