Healthcare Provider Details

I. General information

NPI: 1659878288
Provider Name (Legal Business Name): CAITLIN TAYLOR STEPHENSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2018
Last Update Date: 10/31/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 S MAIN ST
AKRON OH
44301-1664
US

IV. Provider business mailing address

275 MARTINEL DR
KENT OH
44240-4380
US

V. Phone/Fax

Practice location:
  • Phone: 330-644-4095
  • Fax:
Mailing address:
  • Phone: 330-673-6446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: