Provider Demographics
NPI:1598967465
Name:STEBNICKI, MARK A (PHD, LPC, CRC, CCM)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:STEBNICKI
Suffix:
Gender:M
Credentials:PHD, LPC, CRC, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1302A LOUISA LN
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-7013
Mailing Address - Country:US
Mailing Address - Phone:910-251-3724
Mailing Address - Fax:910-762-3587
Practice Address - Street 1:1902 MEETING CT
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-6631
Practice Address - Country:US
Practice Address - Phone:910-251-3724
Practice Address - Fax:910-762-3587
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3468101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional