Provider Demographics
NPI:1053041152
Name:STEPHENS, CASSIDY (MA, LCMHC, LCAS)
Entity Type:Individual
Prefix:
First Name:CASSIDY
Middle Name:
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:MA, LCMHC, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 PARK MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28570-8199
Mailing Address - Country:US
Mailing Address - Phone:850-748-6880
Mailing Address - Fax:
Practice Address - Street 1:530 PARK MEADOWS DR
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:NC
Practice Address - Zip Code:28570-8199
Practice Address - Country:US
Practice Address - Phone:850-748-6880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15222101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor