Provider Demographics
NPI:1124499025
Name:MAGALONG, STEFANIE (LPCC)
Entity type:Individual
Prefix:MRS
First Name:STEFANIE
Middle Name:
Last Name:MAGALONG
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:STEFANIE
Other - Middle Name:
Other - Last Name:NEIDERMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCC
Mailing Address - Street 1:1355 CREEKSIDE DR
Mailing Address - Street 2:APT. 414
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-5683
Mailing Address - Country:US
Mailing Address - Phone:203-306-9294
Mailing Address - Fax:
Practice Address - Street 1:2363 BOULEVARD CIR
Practice Address - Street 2:SUITE 12A
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94595-1177
Practice Address - Country:US
Practice Address - Phone:203-306-9294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-18
Last Update Date:2015-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALPCC2145101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional