Provider Demographics
NPI:1104648740
Name:LEVINE, STACI R (MSW)
Entity type:Individual
Prefix:
First Name:STACI
Middle Name:R
Last Name:LEVINE
Suffix:
Gender:
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:877 BIRDS ML SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-5141
Mailing Address - Country:US
Mailing Address - Phone:770-596-1237
Mailing Address - Fax:
Practice Address - Street 1:1820 THE EXCHANGE SE STE 750
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-2088
Practice Address - Country:US
Practice Address - Phone:678-744-8313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-25
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker