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General NPI Number Information
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NPI Number | 1902108038
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Entity Type | Individual
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Provider Name | STEPHANY WILSON JOY-NEWMAN ED.D., LCPC
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Gender | Female
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Dates
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Enumeration Date | 11/22/2010
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Last Update Date | 07/13/2012
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Provider Practice Location Address
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Address Line | 2048 W ADAMS RD
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City | MACOMB
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State | IL
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Zip | 61455-1220
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Country | US
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Telephone | 309-255-2280
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Fax | 309-836-3354
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Provider Business Mailing Address
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Address Line | 2048 W ADAMS RD PRIVATE COUNSELING SERVICES
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City | MACOMB
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State | IL
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Zip | 61455-1220
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Country | US
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Telephone | 309-255-2280
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Fax | 309-836-3354
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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 | 180.000695
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License Number State | IL
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