Provider Demographics
NPI:1164151338
Name:HALES, STEPHANIE LEE (LSW)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LEE
Last Name:HALES
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4154 SAVANNAH GROVE LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-5680
Mailing Address - Country:US
Mailing Address - Phone:216-870-8631
Mailing Address - Fax:
Practice Address - Street 1:6302 FAIRVIEW RD STE 100
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-2227
Practice Address - Country:US
Practice Address - Phone:704-584-9897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-06
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.2207658104100000X
390200000X
NCP0202301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program