Healthcare Provider Details

I. General information

NPI: 1215873831
Provider Name (Legal Business Name): STEPHANIE GDOVIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 LARGE OAK LN
MEBANE NC
27302-8742
US

IV. Provider business mailing address

316 LARGE OAK LN
MEBANE NC
27302-8742
US

V. Phone/Fax

Practice location:
  • Phone: 603-819-1329
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6216
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: