Healthcare Provider Details

I. General information

NPI: 1295685964
Provider Name (Legal Business Name): JESSICA MARIE STEPHENS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 CENTRAL PARK AVE STE E-506
PINEHURST NC
28374-8803
US

IV. Provider business mailing address

222 CENTRAL PARK AVE STE E-506
PINEHURST NC
28374-8803
US

V. Phone/Fax

Practice location:
  • Phone: 203-981-9876
  • Fax:
Mailing address:
  • Phone: 203-981-9876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA22409
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: