Healthcare Provider Details

I. General information

NPI: 1558769695
Provider Name (Legal Business Name): BARBARA STEPHEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2014
Last Update Date: 12/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 MCNABB SHORTCUT ROAD
LORIS SC
29569-7202
US

IV. Provider business mailing address

199 MCNABB SHORTCUT RD
LORIS SC
29569-7201
US

V. Phone/Fax

Practice location:
  • Phone: 843-756-1403
  • Fax: 843-756-4792
Mailing address:
  • Phone: 843-756-1403
  • Fax: 843-756-4792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: