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General NPI Number Information
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NPI Number | 1417732272
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Entity Type | Individual
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Provider Name | CARMEN STEPHENS DSW, LPCC, CRC
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Gender | Female
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Dates
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Enumeration Date | 08/30/2023
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Last Update Date | 09/05/2023
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Provider Practice Location Address
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Address Line | 224 S. DALLAS AVENUE
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City | SAN BERNARDINO
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State | CA
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Zip | 92410
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Country | US
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Telephone | 909-374-5894
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Fax |
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Provider Business Mailing Address
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Address Line | 1171 E ALOSTA AVE # 344
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City | AZUSA
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State | CA
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Zip | 91702-2740
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 12756
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License Number State | CA
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