Provider Demographics
NPI:1770880692
Name:MONTWID, STEPHANIE G (LPC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:G
Last Name:MONTWID
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11675 CENTURY DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-8366
Mailing Address - Country:US
Mailing Address - Phone:770-864-2125
Mailing Address - Fax:678-551-7229
Practice Address - Street 1:11675 CENTURY DR
Practice Address - Street 2:SUITE C
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-8366
Practice Address - Country:US
Practice Address - Phone:770-864-2125
Practice Address - Fax:678-551-7229
Is Sole Proprietor?:No
Enumeration Date:2011-02-14
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007468101YM0800X
FLMH10344101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health