Healthcare Provider Details

I. General information

NPI: 1346792991
Provider Name (Legal Business Name): MRS. ELISABETH M. STEPHENS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BETH M. STEPHENS CADC

II. Dates (important events)

Enumeration Date: 10/31/2016
Last Update Date: 10/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1241 COLLEGE PARK DR
DOVER DE
19904-8713
US

IV. Provider business mailing address

567 BUTTERPAT RD
HARTLY DE
19953-3348
US

V. Phone/Fax

Practice location:
  • Phone: 302-735-7790
  • Fax: 302-735-3652
Mailing address:
  • Phone: 302-270-5775
  • Fax: 302-735-3652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1618
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: