MEDICARE: STEPHANIE LEEANNE PHELPS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	12354A	NC

General Provider Information

NPI Number	:	1013659614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE LEEANNE PHELPS

Provider Business Mailing Address
First Line	:	2118 QUAIL RIDGE DR
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28304-1320
Country	:	US
Telephone Number	:	910-303-8161
Fax Number	:

Provider Business Practice Location Address
First Line	:	1776 HERITAGE DR. STE 204
Second Line	:
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-3977
Country	:	US
Telephone Number	:	919-971-8744
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2022
Last Update Date	:	04/13/2022

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