Provider Demographics
NPI:1861161606
Name:STEPHENS, MICHAEL (RBT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 JONES FRANKLIN RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-5440
Mailing Address - Country:US
Mailing Address - Phone:919-218-1443
Mailing Address - Fax:
Practice Address - Street 1:1215 JONES FRANKLIN RD STE 101
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606-3351
Practice Address - Country:US
Practice Address - Phone:919-218-1443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-07
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician