Provider Demographics
NPI:1467185108
Name:STEPHENSON, MARIA LYNN
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:LYNN
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 NICKFIELD RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-2040
Mailing Address - Country:US
Mailing Address - Phone:910-644-4535
Mailing Address - Fax:
Practice Address - Street 1:323 NICKFIELD RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-2040
Practice Address - Country:US
Practice Address - Phone:910-644-4535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-08
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician