Provider Demographics
NPI:1194327890
Name:JONSDOTTER, STEFANIE MAXI (MS, LCMHC, NCC, CRC)
Entity type:Individual
Prefix:MISS
First Name:STEFANIE
Middle Name:MAXI
Last Name:JONSDOTTER
Suffix:
Gender:F
Credentials:MS, LCMHC, NCC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 IOWA LN STE 102
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-2401
Mailing Address - Country:US
Mailing Address - Phone:919-244-2975
Mailing Address - Fax:
Practice Address - Street 1:130 IOWA LN STE 102
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-2401
Practice Address - Country:US
Practice Address - Phone:919-585-5085
Practice Address - Fax:919-585-5085
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-09
Last Update Date:2022-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA14927101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health