Provider Demographics
NPI:1295022176
Name:STEPHENS, FREDERICK HODGE (LCSW)
Entity Type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:HODGE
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2302 N BARKER ST
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-3626
Mailing Address - Country:US
Mailing Address - Phone:910-618-9267
Mailing Address - Fax:
Practice Address - Street 1:2302 N BARKER ST
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-3626
Practice Address - Country:US
Practice Address - Phone:910-618-9267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-29
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0072771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical