Individual
KENNETH J STEPHENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
4389 INDIAN TRAIL FAIRVIEW RD STE 23, INDIAN TRAIL, NC 28079-9649
(704) 526-9905
Mailing address
200 DUTCHMANS MEADOW DR, MOUNT HOLLY, NC 28120-3004
(704) 951-0055
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
4811
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0312590692
LIABILITY INSURANCE HPSO
NC
01
—
11871065
CAQH
NC
05
—
6102986
—
NC
01
—
9727178
AETNA
NC
Enumeration date
04/19/2007
Last updated
11/01/2011
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