Stacy D Witherspoon

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

2300 W Park PL
Stone Mountain, GA 30087-6713

Phone

(678) 330-1400

NPI assigned

Jul 6, 2020

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1593993600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1417575507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2300 W PARK PL STE 125",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300873561",
            "telephone_number": "678-330-1400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 W PARK PL",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300876713",
            "telephone_number": "678-330-1400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "736 Deshon Creek Dr",
            "address_purpose": "LOCATION",
            "city": "Lithonia",
            "state": "GA",
            "postal_code": "300582933",
            "country_code": "US",
            "telephone_number": "678-891-8073",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WITHERSPOON",
        "first_name": "STACY",
        "middle_name": "D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-07-06",
        "last_updated": "2023-11-27",
        "certification_date": "2020-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "www.thepotttershouseinc.org",
            "affiliation": "Y",
            "endpointDescription": "website",
            "affiliationName": "The Potters House Family and Children Treatment Center",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Website",
            "address_1": "2300 W Park Pl",
            "city": "Stone Mountain",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300876713",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "www.thepotttershouseinc.org",
            "affiliation": "Y",
            "endpointDescription": "website",
            "affiliationName": "The Potters House Family and Children Treatment Center",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Website",
            "address_1": "2300 W Park Pl",
            "city": "Stone Mountain",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300876713",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Erica Dionne Woods, LPC
• Thomas Crandall Woodson, ATC

• Behavior Technician in Stone Mountain, GA
• Providers in Stone Mountain, GA by specialty
• Behavior Technician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.