Individual
MRS. STEPHANIE WILDER DAVIDSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
133 WILLOW LAKE DR, LEESBURG, GA 31763-5386
(229) 886-8497
Mailing address
133 WILLOW LAKE DR, LEESBURG, GA 31763-5386
(229) 886-8497
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
003623
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1417982190
NPI NUMBER
GA
05
—
381809514A
—
GA
Enumeration date
07/11/2006
Last updated
12/01/2008
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