Provider Demographics
NPI:1740017516
Name:FAISON, STEPHANIE E (LCMHC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:E
Last Name:FAISON
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 1:4201 AUBURN HILLS DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-7875
Mailing Address - Country:US
Mailing Address - Phone:336-834-2405
Mailing Address - Fax:
Practice Address - Street 1:4201 AUBURN HILLS DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-7875
Practice Address - Country:US
Practice Address - Phone:336-834-2405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11934101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty