Provider Demographics
NPI:1912471129
Name:LAFONTAINE, STEPHANIE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:LAFONTAINE
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4318 W CRYSTAL LAKE RD STE L
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-4250
Mailing Address - Country:US
Mailing Address - Phone:815-331-8381
Mailing Address - Fax:815-331-8362
Practice Address - Street 1:4318 W CRYSTAL LAKE ROAD
Practice Address - Street 2:SUITE L
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-4250
Practice Address - Country:US
Practice Address - Phone:815-331-8381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-22
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178012852101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty