Healthcare Provider Details

I. General information

NPI: 1952761090
Provider Name (Legal Business Name): STEPHANIE WATERMAN M.ED., LPCC, CRC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2016
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3645 RIDGE MILL DR
HILLIARD OH
43026-7752
US

IV. Provider business mailing address

624 E MAIN ST
LANCASTER OH
43130-3903
US

V. Phone/Fax

Practice location:
  • Phone: 614-457-7876
  • Fax: 614-457-7896
Mailing address:
  • Phone: 740-687-0042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberE1200514-SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: