Provider Demographics
NPI:1417193012
Name:LESIEUR, STEPHEN THOMAS (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:THOMAS
Last Name:LESIEUR
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 COLFAX CT
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-7971
Mailing Address - Country:US
Mailing Address - Phone:843-849-1149
Mailing Address - Fax:
Practice Address - Street 1:106 BEE ST.
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29401-5799
Practice Address - Country:US
Practice Address - Phone:843-789-7620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-02
Last Update Date:2009-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC85776163WP0808X
SC3697363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health