Provider Demographics
NPI:1245874320
Name:STEPHENS, TRISHA DAWN (LISW)
Entity type:Individual
Prefix:
First Name:TRISHA
Middle Name:DAWN
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:TRISHA
Other - Middle Name:
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4421 EMERSON AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26104-1200
Mailing Address - Country:US
Mailing Address - Phone:304-220-0112
Mailing Address - Fax:304-220-0112
Practice Address - Street 1:4421 EMERSON AVE STE 204
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26104-1200
Practice Address - Country:US
Practice Address - Phone:304-220-0112
Practice Address - Fax:304-220-0112
Is Sole Proprietor?:No
Enumeration Date:2019-11-01
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.23046401041C0700X
WVDP009465681041C0700X
KY2563221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1245874320Medicaid
KY7100791440Medicaid
OH0005592Medicaid