Healthcare Provider Details

I. General information

NPI: 1740318344
Provider Name (Legal Business Name): STEPHANIE ALLYN HARRELL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 09/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 GREAT BRIDGE BLVD
CHESAPEAKE VA
23320-3904
US

IV. Provider business mailing address

224 GREAT BRIDGE BLVD
CHESAPEAKE VA
23320-3904
US

V. Phone/Fax

Practice location:
  • Phone: 757-547-9334
  • Fax: 757-819-6292
Mailing address:
  • Phone: 757-547-9334
  • Fax: 757-819-6292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904008214
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: