Provider Demographics
NPI:1619361458
Name:EDDINS, STEFANI T
Entity Type:Individual
Prefix:
First Name:STEFANI
Middle Name:T
Last Name:EDDINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9637 HANBERRY BLVD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-0225
Mailing Address - Country:US
Mailing Address - Phone:214-564-3681
Mailing Address - Fax:
Practice Address - Street 1:542 WILLIAMSON RD
Practice Address - Street 2:SUITE 6
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8193
Practice Address - Country:US
Practice Address - Phone:704-660-6854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-18
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0089301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical