Provider Demographics
NPI:1255665246
Name:STEPHENS, EDNA (LPC)
Entity Type:Individual
Prefix:
First Name:EDNA
Middle Name:
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 PAGE CT
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-4884
Mailing Address - Country:US
Mailing Address - Phone:704-277-2239
Mailing Address - Fax:803-325-8731
Practice Address - Street 1:219 MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:PINEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28134-7528
Practice Address - Country:US
Practice Address - Phone:704-277-2239
Practice Address - Fax:704-889-3013
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-24
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7511101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional