Provider Demographics
NPI:1124308739
Name:TRENT, STEPHANI (MA)
Entity type:Individual
Prefix:
First Name:STEPHANI
Middle Name:
Last Name:TRENT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 S KANAWHA ST STE 106
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-6967
Mailing Address - Country:US
Mailing Address - Phone:681-238-5600
Mailing Address - Fax:681-238-5601
Practice Address - Street 1:2401 S KANAWHA ST STE 106
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-6967
Practice Address - Country:US
Practice Address - Phone:681-238-5600
Practice Address - Fax:681-238-5601
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-26
Last Update Date:2023-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1027103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical