Provider Demographics
NPI:1508428475
Name:GUFFEY, STEPHANIE RAE (RBT, BCAT, LMT, CNMT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:RAE
Last Name:GUFFEY
Suffix:
Gender:F
Credentials:RBT, BCAT, LMT, CNMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6216 OLD KEENE MILL CT
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-2323
Mailing Address - Country:US
Mailing Address - Phone:571-297-4308
Mailing Address - Fax:703-992-0405
Practice Address - Street 1:6216 OLD KEENE MILL CT
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-2323
Practice Address - Country:US
Practice Address - Phone:571-297-4308
Practice Address - Fax:703-992-0405
Is Sole Proprietor?:No
Enumeration Date:2019-07-01
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019016638225700000X
VARBT-20-140738106S00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist