Provider Demographics
NPI:1063540607
Name:CARROLL, STEPHENIE DIANE (AMFT/ CADC III)
Entity type:Individual
Prefix:MRS
First Name:STEPHENIE
Middle Name:DIANE
Last Name:CARROLL
Suffix:
Gender:F
Credentials:AMFT/ CADC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:5080 CALIFORNIA AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-0794
Mailing Address - Country:US
Mailing Address - Phone:661-634-9877
Mailing Address - Fax:661-864-0198
Practice Address - Street 1:5080 CALIFORNIA AVE STE 100
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-0794
Practice Address - Country:US
Practice Address - Phone:661-634-9877
Practice Address - Fax:661-864-0198
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
CAAMFT132147106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)