Provider Demographics
NPI:1801447453
Name:STEPHENS, CHRISTOPHER DWAYNE (LGPC, CAC-AD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:DWAYNE
Last Name:STEPHENS
Suffix:
Gender:
Credentials:LGPC, CAC-AD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 GRAND DR
Mailing Address - Street 2:
Mailing Address - City:TANEYTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21787-2408
Mailing Address - Country:US
Mailing Address - Phone:717-659-6302
Mailing Address - Fax:
Practice Address - Street 1:181 E MAIN ST STE 4
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-6195
Practice Address - Country:US
Practice Address - Phone:717-659-6302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-25
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP9749101YM0800X
MDLC11562101YM0800X
LC11562101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health