Provider Demographics
NPI:1578839551
Name:LAMB, STEPHANIE ANN (PC)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:ANN
Last Name:LAMB
Suffix:
Gender:F
Credentials:PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 REGENCY RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4221
Mailing Address - Country:US
Mailing Address - Phone:937-396-7077
Mailing Address - Fax:
Practice Address - Street 1:237 S DIXIE DR
Practice Address - Street 2:SUITE 15
Practice Address - City:VANDALIA
Practice Address - State:OH
Practice Address - Zip Code:45377-2144
Practice Address - Country:US
Practice Address - Phone:937-396-7077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-24
Last Update Date:2012-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1000386101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional