Healthcare Provider Details

I. General information

NPI: 1538977004
Provider Name (Legal Business Name): SUSAN LEIGH STEPHENS LCMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2024
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3209 GRESHAM LAKE RD STE 113
RALEIGH NC
27615-4131
US

IV. Provider business mailing address

3209 GRESHAM LAKE RD STE 113
RALEIGH NC
27615-4131
US

V. Phone/Fax

Practice location:
  • Phone: 919-977-5993
  • Fax:
Mailing address:
  • Phone: 919-977-5993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA22833
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number30288
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: