Provider Demographics
NPI:1164647681
Name:DVORAK, STEPHANIE A (LCMHC-S/LCAS)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:A
Last Name:DVORAK
Suffix:
Gender:F
Credentials:LCMHC-S/LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 POPLAR DR W
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:NC
Mailing Address - Zip Code:28752-5405
Mailing Address - Country:US
Mailing Address - Phone:828-724-9194
Mailing Address - Fax:
Practice Address - Street 1:551 BURMA RD W STE 8
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:NC
Practice Address - Zip Code:28752-5583
Practice Address - Country:US
Practice Address - Phone:828-559-9595
Practice Address - Fax:828-544-1201
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4988101YM0800X, 101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102913Medicaid
NC1448KOtherBLUE CROSS / BLUE SHIELD