Healthcare Provider Details

I. General information

NPI: 1548289333
Provider Name (Legal Business Name): STEPHANIE ANN PORTER PHD, LPCS, CCS, MAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: STEPHANIE WILSEY PHD, LPC, LPCS. LCAS

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 N ASPEN ST
LINCOLNTON NC
28092-6303
US

IV. Provider business mailing address

611 CHURCH ST N
CONCORD NC
28025-4322
US

V. Phone/Fax

Practice location:
  • Phone: 704-520-3620
  • Fax: 704-520-3660
Mailing address:
  • Phone: 704-963-9270
  • Fax: 704-963-9038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6437
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5024785
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1052
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: