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General NPI Number Information
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NPI Number | 1962821884
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Entity Type | Individual
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Provider Name | STEPHANIE D AVINGER LCSW-C, LCSW, LICSW
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Gender | Female
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Dates
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Enumeration Date | 04/08/2014
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Last Update Date | 07/01/2025
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Provider Practice Location Address
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Address Line | 466 TOWN PLAZA AVE STE 310
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City | PONTE VEDRA
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State | FL
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Zip | 32081-5185
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Country | US
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Telephone | 443-581-8200
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Fax |
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Provider Business Mailing Address
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Address Line | 4450 TROPEA WAY UNIT 1431
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City | JACKSONVILLE
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State | FL
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Zip | 32246-8885
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Country | US
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Telephone | 267-235-4263
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149027336
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW23132
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 19606
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License Number State | MD
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LC50082946
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License Number State | DC
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