Provider Demographics
NPI:1831613678
Name:BECKER, STEPHANIE LEE (CDP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LEE
Last Name:BECKER
Suffix:
Gender:F
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 VALLEY VIEW WAY
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-1564
Mailing Address - Country:US
Mailing Address - Phone:360-584-0050
Mailing Address - Fax:360-533-3066
Practice Address - Street 1:516 E 1ST ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-4106
Practice Address - Country:US
Practice Address - Phone:360-350-4010
Practice Address - Fax:360-533-9825
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-02
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60715789101YA0400X
WA60715789101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)