Healthcare Provider Details

I. General information

NPI: 1982907697
Provider Name (Legal Business Name): STEPHANIE D. RENDER LPC, LCAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 01/16/2019
Certification Date:
Deactivation Date: 12/13/2010
Reactivation Date: 12/20/2010

III. Provider practice location address

708 S CHESTNUT ST
GASTONIA NC
28054-4548
US

IV. Provider business mailing address

PO BOX 4003
GASTONIA NC
28054-0041
US

V. Phone/Fax

Practice location:
  • Phone: 704-957-3467
  • Fax: 704-867-0638
Mailing address:
  • Phone: 704-957-3467
  • Fax: 704-867-0638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4026
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: