Provider Demographics
NPI:1841322393
Name:FATZINGER, STEPHEN EDWARD (LPA)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:EDWARD
Last Name:FATZINGER
Suffix:
Gender:M
Credentials:LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 OLD FELLOWSHIP RD
Mailing Address - Street 2:
Mailing Address - City:SWANNANOA
Mailing Address - State:NC
Mailing Address - Zip Code:28778-2709
Mailing Address - Country:US
Mailing Address - Phone:828-299-0299
Mailing Address - Fax:828-299-0299
Practice Address - Street 1:299 OLD FELLOWSHIP RD
Practice Address - Street 2:
Practice Address - City:SWANNANOA
Practice Address - State:NC
Practice Address - Zip Code:28778-2709
Practice Address - Country:US
Practice Address - Phone:828-299-0299
Practice Address - Fax:828-299-0299
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1588103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6107233Medicaid
NC1588OtherLPA LICENSE NUMBER