Healthcare Provider Details

I. General information

NPI: 1376913160
Provider Name (Legal Business Name): STEVEN CLINE MA, LMFTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2015
Last Update Date: 04/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 RALEIGH ST
FUQUAY VARINA NC
27526-2263
US

IV. Provider business mailing address

206 RALEIGH ST
FUQUAY VARINA NC
27526-2263
US

V. Phone/Fax

Practice location:
  • Phone: 919-285-4802
  • Fax:
Mailing address:
  • Phone: 919-285-4802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFTA-10099A
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: