Provider Demographics
NPI:1326828179
Name:STEPHENS, WILLIAM DANIEL (LCADC, CSW)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:DANIEL
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:LCADC, CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 HAAS LN
Mailing Address - Street 2:
Mailing Address - City:SELLERSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47172-1125
Mailing Address - Country:US
Mailing Address - Phone:812-987-0462
Mailing Address - Fax:
Practice Address - Street 1:250 HAAS LN
Practice Address - Street 2:
Practice Address - City:SELLERSBURG
Practice Address - State:IN
Practice Address - Zip Code:47172-1125
Practice Address - Country:US
Practice Address - Phone:812-987-0462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY255789101Y00000X
KY1686966579101YA0400X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor