Healthcare Provider Details

I. General information

NPI: 1174088223
Provider Name (Legal Business Name): STEPHANIE RENEE GWINN LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2019
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

523 OAK RIDGE CHURCH RD
CORBIN KY
40701-5238
US

IV. Provider business mailing address

610 SMITH LN
LONDON KY
40741-2822
US

V. Phone/Fax

Practice location:
  • Phone: 606-215-3008
  • Fax:
Mailing address:
  • Phone: 606-215-3008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number281764
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number281674
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number281674
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: