Provider Demographics
NPI:1689097701
Name:BRISCOE, STEPHANIE NICHOL (MA LCMHCS NCC CTMH)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:NICHOL
Last Name:BRISCOE
Suffix:
Gender:F
Credentials:MA LCMHCS NCC CTMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4311 SCHOOL HOUSE CMNS # 178
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28075-7510
Mailing Address - Country:US
Mailing Address - Phone:980-859-3331
Mailing Address - Fax:888-730-1933
Practice Address - Street 1:5663 HAMMERMILL DR
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:NC
Practice Address - Zip Code:28075-3933
Practice Address - Country:US
Practice Address - Phone:980-859-3331
Practice Address - Fax:888-730-1933
Is Sole Proprietor?:No
Enumeration Date:2014-01-24
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10549101YM0800X, 101YP2500X
SC7645101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1689097701Medicaid