Provider Demographics
NPI:1548289333
Name:PORTER, STEPHANIE ANN (PHD, LPCS, CCS, MAC)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:ANN
Last Name:PORTER
Suffix:
Gender:F
Credentials:PHD, LPCS, CCS, MAC
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:WILSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, LPC, LPCS LCAS
Mailing Address - Street 1:112 9TH ST
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28012-3527
Mailing Address - Country:US
Mailing Address - Phone:704-960-9310
Mailing Address - Fax:
Practice Address - Street 1:609 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-3810
Practice Address - Country:US
Practice Address - Phone:704-476-4105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1052101YA0400X
NC6437101YP2500X
NC2038103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6107282Medicaid
NC046TGOtherBCBSNC
NC6107282Medicaid