Provider Demographics
NPI:1265708820
Name:ROBERTSON, STEPHANIE NICOLE (LPC, LAC, AADC, MAC)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:NICOLE
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:LPC, LAC, AADC, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 LEN CT
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-5526
Mailing Address - Country:US
Mailing Address - Phone:864-371-0538
Mailing Address - Fax:
Practice Address - Street 1:364 S PINE ST STE A110
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-2654
Practice Address - Country:US
Practice Address - Phone:864-515-6440
Practice Address - Fax:864-308-2442
Is Sole Proprietor?:No
Enumeration Date:2012-03-28
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC100101YA0400X
SC6403101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)