Provider Demographics
NPI:1851604953
Name:MATTHEWS, STEPHANIE WARD (MS, BCBA, LPES, NCSP)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:WARD
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:MS, BCBA, LPES, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10524 S HIGHWAY 905
Mailing Address - Street 2:
Mailing Address - City:LONGS
Mailing Address - State:SC
Mailing Address - Zip Code:29568-6701
Mailing Address - Country:US
Mailing Address - Phone:843-446-8898
Mailing Address - Fax:
Practice Address - Street 1:10524 S HIGHWAY 905
Practice Address - Street 2:
Practice Address - City:LONGS
Practice Address - State:SC
Practice Address - Zip Code:29568-6701
Practice Address - Country:US
Practice Address - Phone:843-446-8898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-17
Last Update Date:2010-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC103K00000X
SC4552103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool