Provider Demographics
NPI:1346802410
Name:COMBS, STEPHEN C
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:C
Last Name:COMBS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11205 CARRIAGE HOUSE CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-2449
Mailing Address - Country:US
Mailing Address - Phone:540-710-7755
Mailing Address - Fax:
Practice Address - Street 1:2126 JEFFERSON DAVIS HWY STE 103
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-7294
Practice Address - Country:US
Practice Address - Phone:404-291-5330
Practice Address - Fax:540-658-0855
Is Sole Proprietor?:No
Enumeration Date:2019-06-28
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701008403101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional