Basic Information
| Provider Information | |||||||||
| NPI: | 1285107300 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PATTERSON | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | MICHELLE | ||||||||
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| Credential: | LCDC-III | ||||||||
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| Mailing Information | |||||||||
| Address1: | 547 E 11TH AVE | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432112603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142244506 | ||||||||
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| Practice Location | |||||||||
| Address1: | 15802 STATE ROUTE 104 | ||||||||
| Address2: | |||||||||
| City: | CHILLICOTHE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456019701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7407447080 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2019 | ||||||||
| LastUpdateDate: | 01/11/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | LCDC-III.161864 | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.