Provider Demographics
NPI:1518552371
Name:STOCKTON, STEPHAN (LPCMH)
Entity type:Individual
Prefix:MR
First Name:STEPHAN
Middle Name:
Last Name:STOCKTON
Suffix:
Gender:M
Credentials:LPCMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 W 3RD ST # 1
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19801-2320
Mailing Address - Country:US
Mailing Address - Phone:302-507-5813
Mailing Address - Fax:
Practice Address - Street 1:508 W 3RD ST # 1
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19801-2320
Practice Address - Country:US
Practice Address - Phone:302-507-5813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PC-0011063101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health