Basic Information
| Provider Information | |||||||||
| NPI: | 1639721277 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STEPPING STONES THERAPEUTIC SERVICES FOR CHILDREN AND ADULTS, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2748 ANGE ST | ||||||||
| Address2: | |||||||||
| City: | WINTERVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285907913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2527174373 | ||||||||
| FaxNumber: | 2527510849 | ||||||||
| Practice Location | |||||||||
| Address1: | 3105 EVANS ST STE E | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278346899 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2527022298 | ||||||||
| FaxNumber: | 2527510849 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2019 | ||||||||
| LastUpdateDate: | 07/14/2019 | ||||||||
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| AuthorizedOfficialLastName: | SONG | ||||||||
| AuthorizedOfficialFirstName: | TAMMY | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2527174373 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YP2500X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional | 1041C0700X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.