Provider Demographics
NPI:1144649641
Name:BITTLE, STEPHANIE (LCSW)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:BITTLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 SHADY LAWN RD
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-2010
Mailing Address - Country:US
Mailing Address - Phone:919-929-8875
Mailing Address - Fax:
Practice Address - Street 1:400 CRUTCHFIELD ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2771
Practice Address - Country:US
Practice Address - Phone:919-471-6501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-11
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP053329-11041C0700X
NCC0092771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC37994568OtherDRIVER'S LICENSE