Provider Demographics
NPI:1467914135
Name:EATON, STEPHANIE LEIGH (LPC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LEIGH
Last Name:EATON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:LEIGH
Other - Last Name:NORRIS-SARTAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:804 TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-4859
Mailing Address - Country:US
Mailing Address - Phone:662-212-3587
Mailing Address - Fax:
Practice Address - Street 1:198 COUNTY ROAD 305
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-8846
Practice Address - Country:US
Practice Address - Phone:662-415-2365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-02
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YS0200X
MS0705101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Single Specialty