Provider Demographics
NPI:1427545656
Name:PIERCE, STEPHEN W (LCDCIII)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:W
Last Name:PIERCE
Suffix:
Gender:M
Credentials:LCDCIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1487 BREIDING RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44310-2649
Mailing Address - Country:US
Mailing Address - Phone:330-431-9045
Mailing Address - Fax:419-710-1708
Practice Address - Street 1:718 GRAHAM RD
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-1041
Practice Address - Country:US
Practice Address - Phone:330-615-7355
Practice Address - Fax:734-758-0784
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-13
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLCDCIII.162179101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0276793Medicaid