Provider Demographics
NPI:1356422901
Name:SPELLER-HENDERSON, STEPHANIE ROCHELLE (MA,NCC,LPC)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:ROCHELLE
Last Name:SPELLER-HENDERSON
Suffix:
Gender:F
Credentials:MA,NCC,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7221 WALTERBORO RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28227-1243
Mailing Address - Country:US
Mailing Address - Phone:704-566-7190
Mailing Address - Fax:
Practice Address - Street 1:1247 TOM HUNTER RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-7419
Practice Address - Country:US
Practice Address - Phone:704-566-7190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5451101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103288Medicaid