Provider Demographics
NPI:1578054425
Name:STEPHENS, MICKAEL JOHN (BS)
Entity Type:Individual
Prefix:
First Name:MICKAEL
Middle Name:JOHN
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 S CENTER ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT OLIVE
Mailing Address - State:NC
Mailing Address - Zip Code:28365-2124
Mailing Address - Country:US
Mailing Address - Phone:919-635-3344
Mailing Address - Fax:
Practice Address - Street 1:707 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-3503
Practice Address - Country:US
Practice Address - Phone:910-592-4507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-27
Last Update Date:2018-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst