Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY002339 | GA |
Y | 103TC0700X | Clinical Psychologist | PSY002339 | GA |
NPI | 1003990557 |
---|---|
Provider Name | Jennifer Stapel-Wax |
First Address | Atlanta, GA 30329-4010 |
Second Address | Atlanta, GA 30329-4010 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2006 |
Last Update Date | 25/06/2021 |