Provider Demographics
NPI:1639883754
Name:STEPHENS, ELIZABETH (LCSW-A)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 ALABASTER WAY APT J
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-0896
Mailing Address - Country:US
Mailing Address - Phone:405-719-3900
Mailing Address - Fax:
Practice Address - Street 1:907 HAY ST STE 201
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5352
Practice Address - Country:US
Practice Address - Phone:910-483-5986
Practice Address - Fax:910-483-2876
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0186181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical