Provider Demographics
NPI:1891174918
Name:WHARTON, STEPHANIE (PHD, LPCMH, NCC)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:
Last Name:WHARTON
Suffix:
Gender:F
Credentials:PHD, LPCMH, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5149 W WOODMILL DR STE 20
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-4067
Mailing Address - Country:US
Mailing Address - Phone:484-620-3593
Mailing Address - Fax:
Practice Address - Street 1:5149 W WOODMILL DR STE 20
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808
Practice Address - Country:US
Practice Address - Phone:484-883-6523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-21
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0000716101YP2500X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE200147047Medicaid