Provider Demographics
NPI:1912083320
Name:SWEET, STACEY LEAH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:LEAH
Last Name:SWEET
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:STACEY
Other - Middle Name:LEAH
Other - Last Name:FELDMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:1882 PRINCETON AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30337-3536
Mailing Address - Country:US
Mailing Address - Phone:404-274-1219
Mailing Address - Fax:404-996-1220
Practice Address - Street 1:1882 PRINCETON AVE STE 3
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30337-3536
Practice Address - Country:US
Practice Address - Phone:404-274-1219
Practice Address - Fax:404-996-1220
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002714103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical