Healthcare Provider Details

I. General information

NPI: 1063540607
Provider Name (Legal Business Name): STEPHENIE DIANE CARROLL LMFT/ CADC III
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5080 CALIFORNIA AVE STE 100
BAKERSFIELD CA
93309-0794
US

IV. Provider business mailing address

5080 CALIFORNIA AVE STE 100
BAKERSFIELD CA
93309-0794
US

V. Phone/Fax

Practice location:
  • Phone: 661-634-9877
  • Fax: 661-864-0198
Mailing address:
  • Phone: 661-634-9877
  • Fax: 661-864-0198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT156118
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: