Individual
LARRY DANIEL STEPHENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD, PCC
Contact information
Practice address
407 CORPORATE CENTER DR, SUITE # D., VANDALIA, OH 45377-1165
(937) 750-9590
Mailing address
5530 SHADY OAK ST, HUBER HEIGHTS, OH 45424-4238
(937) 235-2244
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
101130
OH
101YP2500X
Professional Counselor
Primary
E0004407
OH
Other
Enumeration date
04/13/2016
Last updated
04/13/2016
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