Provider Demographics
NPI:1891446159
Name:WHITE, STEPHANIE JUNE (MBA)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JUNE
Last Name:WHITE
Suffix:
Gender:F
Credentials:MBA
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:JUNE
Other - Last Name:MCKENZIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MBA
Mailing Address - Street 1:24 FRED BOWLING DR
Mailing Address - Street 2:
Mailing Address - City:CHAPMANVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25508-1209
Mailing Address - Country:US
Mailing Address - Phone:304-687-4715
Mailing Address - Fax:
Practice Address - Street 1:137 PEACH CT
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:WV
Practice Address - Zip Code:25053-7082
Practice Address - Country:US
Practice Address - Phone:304-245-9519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-18
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV15713157OtherCAQH