=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184388464
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATHY MICHELLE STEPHAN MA, LCMHCA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/24/2021
-----------------------------------------------------
Last Update Date | 02/17/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 304 NEW LEICESTER HWY STE A
-----------------------------------------------------
City | ASHEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28806-2021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-232-8934
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 63 MARBLE CT
-----------------------------------------------------
City | HENDERSONVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28792-2985
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-423-1742
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | A17094
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------