Provider Demographics
NPI:1407439755
Name:MERCER, STEPHANIE (MSPSY MSPC LCAS-R)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:MERCER
Suffix:
Gender:F
Credentials:MSPSY MSPC LCAS-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 ROLLING PINES DR
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:NC
Mailing Address - Zip Code:28390-7055
Mailing Address - Country:US
Mailing Address - Phone:757-528-3032
Mailing Address - Fax:
Practice Address - Street 1:21 ROLLING PINES DR
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:NC
Practice Address - Zip Code:28390-7055
Practice Address - Country:US
Practice Address - Phone:757-528-3032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-04
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS27285101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)