MEDICARE: STEPHANIE POUNDS

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	101Y00000X	Counselor
2	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1114290905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE POUNDS

Provider Business Mailing Address
First Line	:	238 BEAVERS MILL RD APT A
Second Line	:
City	:	DANVILLE
State	:	VA
Zip	:	24540-1579
Country	:	US
Telephone Number	:	434-728-1913
Fax Number	:

Provider Business Practice Location Address
First Line	:	238 BEAVERS MILL RD APT A
Second Line	:
City	:	DANVILLE
State	:	VA
Zip	:	24540-1579
Country	:	US
Telephone Number	:	434-728-1913
Fax Number	:

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

Provider Enumeration Date	:	02/09/2012
Last Update Date	:	02/09/2012

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