Healthcare Provider Details

I. General information

NPI: 1023378254
Provider Name (Legal Business Name): STONEBRIDGE COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2012
Last Update Date: 02/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 PEMBERTON HILL RD SUITE 103
APEX NC
27502-3957
US

IV. Provider business mailing address

1101 PEMBERTON HILL RD SUITE 103
APEX NC
27502-3957
US

V. Phone/Fax

Practice location:
  • Phone: 919-434-6398
  • Fax: 919-557-2089
Mailing address:
  • Phone: 919-434-6398
  • Fax: 919-557-2089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7714
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC007423
License Number StateNC

VIII. Authorized Official

Name: MS. KATHRYN SHELDON
Title or Position: PRACTICE MANAGER
Credential:
Phone: 919-434-6398