Provider Demographics
NPI:1356606826
Name:STEPHENS, ANITA MARIA (MS, LPC, NCSP)
Entity type:Individual
Prefix:MS
First Name:ANITA
Middle Name:MARIA
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:MS, LPC, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 HALL DR
Mailing Address - Street 2:
Mailing Address - City:BAKER
Mailing Address - State:LA
Mailing Address - Zip Code:70714-5304
Mailing Address - Country:US
Mailing Address - Phone:225-775-0132
Mailing Address - Fax:
Practice Address - Street 1:4332 RHODA DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-4136
Practice Address - Country:US
Practice Address - Phone:225-235-7273
Practice Address - Fax:225-308-4025
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1499101YP2500X
LAAN002462103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool