Provider Demographics
NPI:1326850702
Name:STEPHENSON, HOLLY ANNE (LCSW)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:ANNE
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 W MAINE AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-4703
Mailing Address - Country:US
Mailing Address - Phone:650-215-0127
Mailing Address - Fax:
Practice Address - Street 1:1295 OLD US 1 HWY
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-6347
Practice Address - Country:US
Practice Address - Phone:910-725-0211
Practice Address - Fax:910-725-0311
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0178431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty