Provider Demographics
NPI:1992871685
Name:CANADA, STEPHANIE ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:ANN
Last Name:CANADA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:600 MAHONE ST
Mailing Address - Street 2:APT # 7
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-8929
Mailing Address - Country:US
Mailing Address - Phone:312-203-3676
Mailing Address - Fax:919-416-8883
Practice Address - Street 1:1530 N GREGSON ST
Practice Address - Street 2:SUITE 3A
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-1155
Practice Address - Country:US
Practice Address - Phone:919-416-1830
Practice Address - Fax:919-416-8883
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC3311103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist