Provider Demographics
NPI:1396209060
Name:STEPHENS, COURTNEY NICOL (MSW,ASW)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:NICOL
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:MSW,ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 MOSSWOOD DR
Mailing Address - Street 2:
Mailing Address - City:OAKLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94561-1768
Mailing Address - Country:US
Mailing Address - Phone:510-754-7382
Mailing Address - Fax:
Practice Address - Street 1:545 ESTUDILLO AVE
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-4611
Practice Address - Country:US
Practice Address - Phone:510-746-1191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW86652101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health