Provider Demographics
NPI:1245601475
Name:HUNT, STEPHANIE (LCAS-A)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:HUNT
Suffix:
Gender:F
Credentials:LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 DRAKES BRANCH DR
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NC
Mailing Address - Zip Code:28372-7325
Mailing Address - Country:US
Mailing Address - Phone:910-521-0092
Mailing Address - Fax:
Practice Address - Street 1:30 DRAKES BRANCH DR
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:NC
Practice Address - Zip Code:28372-7325
Practice Address - Country:US
Practice Address - Phone:910-521-0092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-14
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22142101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)