Individual
DR. STACEY SMOOT OWEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
5398 THOMASTON RD, SUITE B, MACON, GA 31220-8110
(478) 476-8868
(478) 476-8161
Mailing address
5398 THOMASTON RD, SUITE B, MACON, GA 31220-8110
(478) 476-8868
(478) 476-8161
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY003006
GA
Other
Enumeration date
01/25/2007
Last updated
07/08/2007
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