Provider Demographics
NPI:1699113720
Name:LE, STEPHANIE MARIE (MD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MARIE
Last Name:LE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 FAISON DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-3210
Mailing Address - Country:US
Mailing Address - Phone:803-935-7140
Mailing Address - Fax:
Practice Address - Street 1:15 MED PARK STE 141
Practice Address - Street 2:GENERAL PSYCHIATRY DEPT
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203
Practice Address - Country:US
Practice Address - Phone:803-434-4300
Practice Address - Fax:803-434-4351
Is Sole Proprietor?:No
Enumeration Date:2013-06-11
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SCLL358052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry