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General NPI Number Information
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NPI Number | 1467987578
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Entity Type | Individual
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Provider Name | STEPHANIE STAVINOGA LPC
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Gender | Female
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Dates
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Enumeration Date | 04/26/2017
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Last Update Date | 04/26/2017
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Provider Practice Location Address
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Address Line | 567 CASON LN STE A
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City | MURFREESBORO
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State | TN
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Zip | 37128-4871
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Country | US
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Telephone | 615-440-8294
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Fax |
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Provider Business Mailing Address
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Address Line | 4550 ROCKDALE FELLOWSHIP RD
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City | MOUNT JULIET
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State | TN
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Zip | 37122-7728
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Country | US
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Telephone | 615-440-8294
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 3758
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License Number State | TN
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