Provider Demographics
NPI:1659590057
Name:MACGREGOR, STEPHEN MAYO (MA LMHC)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:MAYO
Last Name:MACGREGOR
Suffix:
Gender:M
Credentials:MA LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 ROLLINGWOOD CIRCLE N.W.
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1748
Mailing Address - Country:US
Mailing Address - Phone:941-268-3685
Mailing Address - Fax:
Practice Address - Street 1:6 MATHIAS DR.
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-7015
Practice Address - Country:US
Practice Address - Phone:941-258-3144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8247101YM0800X
GALPC007208101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health