Provider Demographics
NPI:1356695282
Name:HENDRIX, STEPHEN D (LPC)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:D
Last Name:HENDRIX
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 20832
Mailing Address - Street 2:
Mailing Address - City:SAINT SIMONS ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31522-0432
Mailing Address - Country:US
Mailing Address - Phone:912-401-5969
Mailing Address - Fax:
Practice Address - Street 1:2487 DEMERE RD
Practice Address - Street 2:SUITE 500
Practice Address - City:SAINT SIMONS ISLAND
Practice Address - State:GA
Practice Address - Zip Code:31522-5639
Practice Address - Country:US
Practice Address - Phone:912-401-5969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-30
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA122409101YA0400X
GAAPC004704101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)