Provider Demographics
NPI:1154892917
Name:ORDON, STEPHANIE (LCSW)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:ORDON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 E PONCE DE LEON AVE STE 240
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-3452
Mailing Address - Country:US
Mailing Address - Phone:770-410-8702
Mailing Address - Fax:
Practice Address - Street 1:235 E PONCE DE LEON AVE STE 240
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-3452
Practice Address - Country:US
Practice Address - Phone:770-410-8702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-05
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0072391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical