Provider Demographics
NPI:1134496102
Name:JUSTICE, STEPHANIE L (LCSW)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:L
Last Name:JUSTICE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1229 JOHN AUSTIN CT
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-3764
Mailing Address - Country:US
Mailing Address - Phone:281-619-4555
Mailing Address - Fax:
Practice Address - Street 1:1229 JOHN AUSTIN CT
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-3764
Practice Address - Country:US
Practice Address - Phone:281-619-4555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-18
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX508891041C0700X
NCC0077041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical