Provider Demographics
NPI:1255580338
Name:ALSUP, STEPHANIE PAIGE (LPC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:PAIGE
Last Name:ALSUP
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:PAIGE
Other - Last Name:DICUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:1815 PLEASANT GROVE ROAD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72405-7870
Mailing Address - Country:US
Mailing Address - Phone:870-933-6886
Mailing Address - Fax:870-933-9395
Practice Address - Street 1:1425 W MAIN STREET
Practice Address - Street 2:
Practice Address - City:WALNUT RIDGE
Practice Address - State:AR
Practice Address - Zip Code:72476-1431
Practice Address - Country:US
Practice Address - Phone:870-886-5303
Practice Address - Fax:870-886-7002
Is Sole Proprietor?:No
Enumeration Date:2008-09-15
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
ARP1303027101YP2500X
AR101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5UU03OtherBCBS
AR174003795Medicaid