Provider Demographics
NPI:1841461316
Name:STEPHENS, CAROLYN KAY (LPC AND PSYCH)
Entity type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:KAY
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:LPC AND PSYCH
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:KAY
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC AND PSYCH
Mailing Address - Street 1:HC 78 BOX 230-12
Mailing Address - Street 2:
Mailing Address - City:HINTON
Mailing Address - State:WV
Mailing Address - Zip Code:25951-8704
Mailing Address - Country:US
Mailing Address - Phone:304-466-4444
Mailing Address - Fax:
Practice Address - Street 1:104 JAMES ST.
Practice Address - Street 2:
Practice Address - City:HINTON
Practice Address - State:WV
Practice Address - Zip Code:25951
Practice Address - Country:US
Practice Address - Phone:304-466-4444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-12
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TS0200X
WV22061103TS0200X
WV1246101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV9203035000Medicaid