Healthcare Provider Details

I. General information

NPI: 1023936580
Provider Name (Legal Business Name): DWIGHT DEVAUGHN STEPHENS LMHC, MCAP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11440 SW 3RD ST
PLANTATION FL
33325-2906
US

IV. Provider business mailing address

11440 SW 3RD ST
PLANTATION FL
33325-2906
US

V. Phone/Fax

Practice location:
  • Phone: 954-809-5288
  • Fax:
Mailing address:
  • Phone: 954-809-5288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberMH8905
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: