Provider Demographics
NPI:1760563167
Name:PRICE, STEPHEN KENNEDY (MA, LPC, LMFT)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:KENNEDY
Last Name:PRICE
Suffix:
Gender:M
Credentials:MA, LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:5401 FALLOWATER LN
Mailing Address - Street 2:SUITE C
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-0948
Mailing Address - Country:US
Mailing Address - Phone:540-989-1383
Mailing Address - Fax:540-989-8092
Practice Address - Street 1:5401 FALLOWATER LN
Practice Address - Street 2:SUITE C
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-0948
Practice Address - Country:US
Practice Address - Phone:540-989-1383
Practice Address - Fax:540-989-8092
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0701003112101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA319781OtherANTHEM