Provider Demographics
NPI:1346792991
Name:STEPHENS, ELISABETH M
Entity Type:Individual
Prefix:MRS
First Name:ELISABETH
Middle Name:M
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:BETH
Other - Middle Name:M
Other - Last Name:STEPHENS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CADC
Mailing Address - Street 1:567 BUTTERPAT RD
Mailing Address - Street 2:
Mailing Address - City:HARTLY
Mailing Address - State:DE
Mailing Address - Zip Code:19953-3348
Mailing Address - Country:US
Mailing Address - Phone:302-270-5775
Mailing Address - Fax:302-735-3652
Practice Address - Street 1:1241 COLLEGE PARK DR
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-8713
Practice Address - Country:US
Practice Address - Phone:302-735-7790
Practice Address - Fax:302-735-3652
Is Sole Proprietor?:No
Enumeration Date:2016-10-31
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE1618101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)