Provider Demographics
NPI:1831649789
Name:WILLEY, STEPHANIE (LMSW)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:WILLEY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 NORTH AVE NE
Mailing Address - Street 2:APT 2505
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2411
Mailing Address - Country:US
Mailing Address - Phone:616-340-2100
Mailing Address - Fax:
Practice Address - Street 1:215 NORTH AVE NE
Practice Address - Street 2:APT 2505
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2411
Practice Address - Country:US
Practice Address - Phone:616-340-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW006907104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker