Individual
STACIE BETHEA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
2001 MARTIN LUTHER KING JR DR SW, SUITE 409, ATLANTA, GA 30310-1101
(404) 564-6486
(404) 564-6487
Mailing address
184 WILLOW SPRINGS LN, STOCKBRIDGE, GA 30281-6228
(917) 848-5567
(404) 564-6487
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
GA
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
GA
101YM0800X
Mental Health Counselor
—
GA
104100000X
Social Worker
Primary
—
GA
1041C0700X
Clinical Social Worker
—
GA
Other
Enumeration date
09/22/2014
Last updated
09/22/2014
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