Provider Demographics
NPI:1225300718
Name:VAN HOUTEN, STEPHANIE L (LCSW, CADC III)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:L
Last Name:VAN HOUTEN
Suffix:
Gender:F
Credentials:LCSW, CADC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 BANCROFT RD # 193
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-1531
Mailing Address - Country:US
Mailing Address - Phone:714-319-9808
Mailing Address - Fax:
Practice Address - Street 1:2731 SYSTRON DR
Practice Address - Street 2:SUITE 250
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94518
Practice Address - Country:US
Practice Address - Phone:925-357-0762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-31
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB0000580220101YA0400X
CA100583104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)