Provider Demographics
NPI:1922241694
Name:HUEY, STEPHANIE DENISE (LCAS-P,MED,QP)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:DENISE
Last Name:HUEY
Suffix:
Gender:F
Credentials:LCAS-P,MED,QP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 SANDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-1247
Mailing Address - Country:US
Mailing Address - Phone:910-488-2599
Mailing Address - Fax:910-488-2701
Practice Address - Street 1:5400 SANDSTONE DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28311-1247
Practice Address - Country:US
Practice Address - Phone:910-488-2599
Practice Address - Fax:910-488-2701
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-10
Last Update Date:2009-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
NC103K00000X, 171M00000X, 172V00000X, 251S00000X, 253J00000X, 320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No172V00000XOther Service ProvidersCommunity Health Worker
No251S00000XAgenciesCommunity/Behavioral Health
No253J00000XAgenciesFoster Care Agency
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness