Provider Demographics
NPI:1821144114
Name:STEPHENSON, JUDY BEACHAM (PHD)
Entity Type:Individual
Prefix:DR
First Name:JUDY
Middle Name:BEACHAM
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:JUDY
Other - Middle Name:B
Other - Last Name:STEPHENSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:140 STRAWBERRY LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-8652
Mailing Address - Country:US
Mailing Address - Phone:910-347-2208
Mailing Address - Fax:910-347-1921
Practice Address - Street 1:140 STRAWBERRY LN
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-8652
Practice Address - Country:US
Practice Address - Phone:910-347-2208
Practice Address - Fax:910-347-1921
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC603101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health