Provider Demographics
NPI:1831072107
Name:STEPHENS, OLUYEMI ADETUNJI SR (LCMCHA)
Entity type:Individual
Prefix:
First Name:OLUYEMI
Middle Name:ADETUNJI
Last Name:STEPHENS
Suffix:SR
Gender:M
Credentials:LCMCHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9370 FALLS OF NEUSE RD STE 203
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-2487
Mailing Address - Country:US
Mailing Address - Phone:910-885-3780
Mailing Address - Fax:
Practice Address - Street 1:9370 FALLS OF NEUSE RD STE 203
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-2487
Practice Address - Country:US
Practice Address - Phone:910-885-3780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-25
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA21596101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health