Provider Demographics
NPI:1134458565
Name:STEPHENS, MARY ANGELA (LPC)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ANGELA
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 906
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35476-0906
Mailing Address - Country:US
Mailing Address - Phone:205-861-3010
Mailing Address - Fax:
Practice Address - Street 1:1002 MCFARLAND BLVD
Practice Address - Street 2:SUITE G
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35476-3370
Practice Address - Country:US
Practice Address - Phone:205-861-3010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-14
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3186101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health