Provider Demographics
NPI:1780136341
Name:KINCAID, STEFANIE JOHNSON (MED, NCC, LPCA)
Entity type:Individual
Prefix:MRS
First Name:STEFANIE
Middle Name:JOHNSON
Last Name:KINCAID
Suffix:
Gender:F
Credentials:MED, NCC, LPCA
Other - Prefix:MS
Other - First Name:STEFANIE
Other - Middle Name:RAE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, NCC, LPCA
Mailing Address - Street 1:105 MESSER DR
Mailing Address - Street 2:
Mailing Address - City:SILER CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27344-1431
Mailing Address - Country:US
Mailing Address - Phone:919-618-0446
Mailing Address - Fax:
Practice Address - Street 1:800 W WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-5203
Practice Address - Country:US
Practice Address - Phone:919-335-3105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-31
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA12410101YM0800X
NC101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool