Provider Demographics
NPI:1255878708
Name:FU, STEPHANIE (LCMHC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:FU
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6649 CLARKSBURG PL
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-5880
Mailing Address - Country:US
Mailing Address - Phone:919-656-5709
Mailing Address - Fax:
Practice Address - Street 1:1145 EXECUTIVE CIR STE D
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-4586
Practice Address - Country:US
Practice Address - Phone:919-656-5709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-23
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA12503101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health