Healthcare Provider Details

I. General information

NPI: 1508428475
Provider Name (Legal Business Name): STEPHANIE RAE GUFFEY RBT, BCAT, LMT, CNMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2019
Last Update Date: 08/18/2021
Certification Date: 08/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6216 OLD KEENE MILL CT
SPRINGFIELD VA
22152-2323
US

IV. Provider business mailing address

6216 OLD KEENE MILL CT
SPRINGFIELD VA
22152-2323
US

V. Phone/Fax

Practice location:
  • Phone: 571-297-4308
  • Fax: 703-992-0405
Mailing address:
  • Phone: 571-297-4308
  • Fax: 703-992-0405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number0019016638
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-140738
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: