MEDICARE: MS. STEPHANIE KATHARINE MORELL MS, LPCA, LCASA, PVE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	LCASA 3056-A	NC
3	101YM0800X	Mental Health Counselor	LPCA- A9865	NC

General Provider Information

NPI Number	:	1376889923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. STEPHANIE KATHARINE MORELL MS, LPCA, LCASA, PVE

Provider Business Mailing Address
First Line	:	116 BREEZEWOOD DR
Second Line	:	APT E
City	:	GREENVILLE
State	:	NC
Zip	:	27858-8838
Country	:	US
Telephone Number	:	252-902-5101
Fax Number	:

Provider Business Practice Location Address
First Line	:	2130 FOREST HILLS RD W
Second Line	:	STE A
City	:	WILSON
State	:	NC
Zip	:	27893-3680
Country	:	US
Telephone Number	:	252-265-9200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2012
Last Update Date	:	12/28/2012

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