Healthcare Provider Details

I. General information

NPI: 1841461316
Provider Name (Legal Business Name): CAROLYN KAY STEPHENS LPC AND PSYCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CAROLYN KAY MILLER LPC AND PSYCH

II. Dates (important events)

Enumeration Date: 03/12/2008
Last Update Date: 08/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 JAMES ST.
HINTON WV
25951
US

IV. Provider business mailing address

HC 78 BOX 230-12
HINTON WV
25951-8704
US

V. Phone/Fax

Practice location:
  • Phone: 304-466-4444
  • Fax:
Mailing address:
  • Phone: 304-466-4444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1246
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number22061
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: