Provider Demographics
NPI:1114482981
Name:STEPHENSON, KAREN M (LCAC)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:M
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10105 N EAGLE ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:ROME CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46784-9791
Mailing Address - Country:US
Mailing Address - Phone:260-740-1092
Mailing Address - Fax:
Practice Address - Street 1:10105 N EAGLE ISLAND RD
Practice Address - Street 2:
Practice Address - City:ROME CITY
Practice Address - State:IN
Practice Address - Zip Code:46784-9791
Practice Address - Country:US
Practice Address - Phone:260-740-1092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-06
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN87001604A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)