Provider Demographics
NPI:1063009306
Name:STEVENSON, SANTIA SADE (LMSW)
Entity type:Individual
Prefix:MS
First Name:SANTIA
Middle Name:SADE
Last Name:STEVENSON
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:P.O. BOX 1132
Mailing Address - Street 2:
Mailing Address - City:OXFORD.
Mailing Address - State:GA
Mailing Address - Zip Code:30054
Mailing Address - Country:US
Mailing Address - Phone:678-724-7805
Mailing Address - Fax:
Practice Address - Street 1:1350 SCENIC HWY N
Practice Address - Street 2:SUITE 266
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078
Practice Address - Country:US
Practice Address - Phone:770-569-3532
Practice Address - Fax:770-358-5200
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-21
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW007309104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker