Provider Demographics
NPI:1629788294
Name:STEPHENS, MARY ALYCIA (LICSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ALYCIA
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 PATTON CREEK LN
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35226-2249
Mailing Address - Country:US
Mailing Address - Phone:205-936-0555
Mailing Address - Fax:
Practice Address - Street 1:1707 PATTON CREEK LN
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35226-2249
Practice Address - Country:US
Practice Address - Phone:205-936-0555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5176C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical