Provider Demographics
NPI:1720730138
Name:GUILLEN, STEPHANIE (LMFTA)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:GUILLEN
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:PAPPAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:933 LOUISE AVE STE 226
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-2147
Mailing Address - Country:US
Mailing Address - Phone:980-292-5350
Mailing Address - Fax:
Practice Address - Street 1:933 LOUISE AVE STE 226
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2147
Practice Address - Country:US
Practice Address - Phone:980-292-5350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-26
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12366A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist