Healthcare Provider Details

I. General information

NPI: 1275458283
Provider Name (Legal Business Name): STEPHANIE LYNN CORCORAN PHD, NCSP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3104 BLUE LAKE DR STE 100
VESTAVIA AL
35243-2372
US

IV. Provider business mailing address

3104 BLUE LAKE DR STE 100
VESTAVIA AL
35243-2372
US

V. Phone/Fax

Practice location:
  • Phone: 205-977-3003
  • Fax: 205-977-3939
Mailing address:
  • Phone: 205-977-3003
  • Fax: 205-977-3939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2459
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: