Healthcare Provider Details

I. General information

NPI: 1568018182
Provider Name (Legal Business Name): STEPHANIE J GARCIA NCC,BCCC,LCMHC,PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: STEPHANIE J CAMPBELL MS

II. Dates (important events)

Enumeration Date: 08/11/2019
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 WESTERN BLVD SUITE L2 BOX 109
JACKSONVILLE NC
28546
US

IV. Provider business mailing address

1250 WESTERN BLVD SUITE L2 BOX 109
JACKSONVILLE NC
28546
US

V. Phone/Fax

Practice location:
  • Phone: 910-541-1883
  • Fax:
Mailing address:
  • Phone: 910-541-1883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number15025
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: