Provider Demographics
NPI:1982907697
Name:RENDER, STEPHANIE D (LPC, LCAS)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:D
Last Name:RENDER
Suffix:
Gender:F
Credentials:LPC, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4003
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-0041
Mailing Address - Country:US
Mailing Address - Phone:704-957-3467
Mailing Address - Fax:704-867-0638
Practice Address - Street 1:708 S CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-4548
Practice Address - Country:US
Practice Address - Phone:704-957-3467
Practice Address - Fax:704-867-0638
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2019-01-16
Deactivation Date:2010-12-13
Deactivation Code:
Reactivation Date:2010-12-20
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
NC4026101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)