Healthcare Provider Details

I. General information

NPI: 1265551329
Provider Name (Legal Business Name): CARL L STEPHENS LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 02/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 DEERWOODS CT
MYERSVILLE MD
21773-8432
US

IV. Provider business mailing address

17 DEERWOODS CT
MYERSVILLE MD
21773
US

V. Phone/Fax

Practice location:
  • Phone: 301-293-1300
  • Fax: 301-293-1911
Mailing address:
  • Phone: 301-293-1300
  • Fax: 301-293-1911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC2159
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: