STACY D WITHERSPOON (NPI# 1417575507) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417575507 |
| Entity Type | Individual |
| Full Name | STACY D WITHERSPOON |
| Practice Address |
2300 W Park Pl Stone Mountain GA 30087-6713 |
| Mailing Address |
2300 W Park Pl Ste 125 Stone Mountain GA 30087-3561 |
| Practice Telephone | 6783301400 |
| Mailing Telephone | 6783301400 |
| Enumeration Date | 2020-07-06 |
| Last Update Date | 2020-07-06 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 106S00000X | Behavior Technician | Behavioral Health & Social Service Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 736 Deshon Creek Dr, Lithonia, GA 300582933 | 6788918073 |
| Street Address |
2300 W PARK PL |
| City | STONE MOUNTAIN |
| State | GA |
| Zip Code | 30087-6713 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891264586 | Sabrina Tolson | Counselor | 2300 W Park Pl, Stone Mountain, GA 30087-6713 | 2018-11-25 |
| 1528538246 | Carmella Andrea Gayle | Counselor | 2300 W Park Pl, Stone Mountain, GA 30087-6713 | 2018-11-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477176394 | Optimal Choice Telehealth | General Practice | 1227 Rockbidge Rd Sw, Ste 208-354, Stone Mountain, GA 30087 | 2020-05-27 |
| 1245882943 | Lynell Williams | Counselor | 505 Lilburn-stone Mountain Road, Suite 235, Stone Mountain, GA 30087 | 2019-07-12 |
| 1003302688 | Mark Andrew Stevens | Physical Therapist | 1227 Rockbridge Rd Ste 402, Stone Mountain, GA 30087 | 2018-07-06 |
| 1154816825 | Tuan Minh Khong | Physician Assistant | 6301 Southland Rdg, Stone Mountain, GA 30087 | 2018-06-26 |
| 1215429881 | Stephanie Martin | Nurse Practitioner | 2720 S Rockbridge Rd, Stone Mountain, GA 30087 | 2018-05-30 |
| 1578979381 | Edmund Thomas Jr. | Dentist | 2536 Rockbridge Rd Ste 103, Stone Mountain, GA 30087 | 2014-07-02 |
| 1790027688 | Robert Fanning Eaves Jr. | General Practice | 5394 Leatherstocking Lane, Stone Mountain, GA 30087 | 2013-03-19 |
| 1609128917 | Mary Marlene Muse | Lactation Consultant, Non-RN | 510 Navarre Drive, Stone Mountain, GA 30087 | 2012-10-10 |
| 1457680704 | Cleo Evans | Counselor | 5638 Manassas Run, Stone Mountain, GA 30087 | 2009-12-16 |
| 1932348521 | Lawrence Randy Sheber | Dentist | 5500-a Lilburn Stone Mountain Road, Stone Mountain, GA 30087 | 2009-02-05 |
| Find all providers in zip 30087 | ||||
| Taxonomy Code | 106S00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Behavior Technician |
| The behavior technician is a paraprofessional who practices under the close, ongoing supervision of a behavior analyst or assistant behavior analyst certified by the Behavior Analyst Certification Board and/or credentialed by a state (such as through licensure). The behavior technician is primarily responsible for the implementation of components of behavior-analytic treatment plans developed by the supervisor. That may include collecting data on treatment targets and conducting certain types of behavioral assessments (e.g., stimulus preference assessments). The behavior technician does not design treatment or assessment plans or procedures but provides services as assigned by the supervisor responsible for his or her work. |
| Notes: Association of Professional Behavior Analysts, www.apbahome.net and Behavior Analyst Certification Board (http://www.bacb.com) [7/1/2016: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760083802 | Alyssa Toney | Behavior Technician | 4606 Treehills Pkwy, Stone Mountain, GA 30088-3088 | 2020-11-05 |
| 1437773975 | Miranda Sturdivant | Behavior Technician | 7 Hidden Chase Apt E, Stone Mountain, GA 30088-4264 | 2020-06-01 |
| 1356987234 | Stephanie Claire Saulsbury | Behavior Technician | 3855 Wood Path Dr, Stone Mountain, GA 30083-4667 | 2019-11-26 |
| 1356902662 | Patrea Bouie | Behavior Technician | 999 Redan Trce, Stone Mountain, GA 30088-2562 | 2019-06-26 |
| 1639737893 | Goldie Lewis | Behavior Technician | 5157 Scarbrough Trl W, Stone Mountain, GA 30088-4326 | 2019-06-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609477694 | Elizabeth Cobb | Behavior Technician | 2147 Newnan Crossing Blvd E, Newnan, GA 30265-2406 | 2020-11-05 |
| 1699376855 | Megan Elizabeth Lee Johnsoln | Behavior Technician | 700 Preston Glen Cir, Apt. 303, Canton, GA 30114-3011 | 2020-11-04 |
| 1730789504 | Fabian Alejandro Martinez | Behavior Technician | 470 16th St Nw Apt 1028, Atlanta, GA 30363-3003 | 2020-10-29 |
| 1336749258 | Rosalyn E Williams | Behavior Technician | 1050 Rock Quarry Rd Apt 100, Stockbridge, GA 30281-6404 | 2020-10-29 |
| 1306446448 | Kristen West | Behavior Technician | 3552 Orchard Cir, Decatur, GA 30032-2510 | 2020-10-28 |
| 1376143461 | Marika Deliyianni | Behavior Technician | 9645 Pine Thicket Way, Roswell, GA 30075-4331 | 2020-10-28 |
| 1932709037 | Missy Nicole Day | Behavior Technician | 310 Northlake Dr Apt 32, Warner Robins, GA 31093-1675 | 2020-10-28 |
| 1497355416 | Devonta Markeice Lancaster | Behavior Technician | 2200 Satellite Blvd Apt 701, Duluth, GA 30097-4018 | 2020-10-28 |
| 1316547607 | Nyasia Phillips | Behavior Technician | 126 Smart Ln, Sylvania, GA 30467-8269 | 2020-10-27 |
| 1487254637 | Leatrice Byers | Behavior Technician | 3355 Mcdaniel Rd Apt 4308, Duluth, GA 30096-8629 | 2020-10-27 |
| Find all providers with the same taxonomy | ||||
| City | STONE MOUNTAIN |
| Zip Code | 30087 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.