Individual
CAROL L STEPHENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CADC I
Contact information
Practice address
109 N.E. MANZANITA AVE, GRANTS PASS, OR 97526-1400
(541) 479-8847
(541) 471-2679
Mailing address
109 N.E. MANZANITA AVE, GRANTS PASS, OR 97526-1400
(541) 479-8847
(541) 471-2679
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
15-01-12
OR
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101YA0400X
—
OR
05
—
500701179
—
OR
Enumeration date
09/24/2015
Last updated
10/10/2019
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