Provider Demographics
NPI:1023378254
Name:STONEBRIDGE COUNSELING PLLC
Entity Type:Organization
Organization Name:STONEBRIDGE COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-434-6398
Mailing Address - Street 1:1101 PEMBERTON HILL RD SUITE 103
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-3957
Mailing Address - Country:US
Mailing Address - Phone:919-434-6398
Mailing Address - Fax:919-557-2089
Practice Address - Street 1:1101 PEMBERTON HILL RD SUITE 103
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-3957
Practice Address - Country:US
Practice Address - Phone:919-434-6398
Practice Address - Fax:919-557-2089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-22
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7714101YM0800X
NCC0074231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6106337Medicaid
NC6107498Medicaid