Provider Demographics
NPI:1538832050
Name:ANDERTON, STEPHANIE MOORE (LCSW; LCAS)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MOORE
Last Name:ANDERTON
Suffix:
Gender:F
Credentials:LCSW; LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 OWEN DR STE 103
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3412
Mailing Address - Country:US
Mailing Address - Phone:910-273-1393
Mailing Address - Fax:
Practice Address - Street 1:951 S MCPHERSON CHURCH RD STE 105
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-5383
Practice Address - Country:US
Practice Address - Phone:910-273-1393
Practice Address - Fax:910-764-6756
Is Sole Proprietor?:No
Enumeration Date:2021-07-29
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27562101YA0400X
NCC0170271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)