Provider Demographics
NPI:1710257936
Name:CHAMPLIN, STEPHENIE R (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:STEPHENIE
Middle Name:R
Last Name:CHAMPLIN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3505 CADILLAC AVE
Mailing Address - Street 2:BLDG O, SUITE 109
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-1429
Mailing Address - Country:US
Mailing Address - Phone:714-432-9856
Mailing Address - Fax:714-432-7075
Practice Address - Street 1:3505 CADILLAC AVE
Practice Address - Street 2:BLDG O, SUITE 109
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-1429
Practice Address - Country:US
Practice Address - Phone:714-432-9856
Practice Address - Fax:714-432-7075
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-04
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
CALCSW 742431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker