Provider Demographics
NPI:1710903570
Name:ROSS, STEPHEN CARL (MA, CAC, LPC)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:CARL
Last Name:ROSS
Suffix:
Gender:M
Credentials:MA, CAC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 WOLF CREEK RD
Mailing Address - Street 2:
Mailing Address - City:BERNVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19506-8694
Mailing Address - Country:US
Mailing Address - Phone:610-488-7363
Mailing Address - Fax:
Practice Address - Street 1:179 WOLF CREEK RD
Practice Address - Street 2:
Practice Address - City:BERNVILLE
Practice Address - State:PA
Practice Address - Zip Code:19506-8694
Practice Address - Country:US
Practice Address - Phone:610-488-7363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC002496101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health