Provider Demographics
NPI:1679303200
Name:FREDERICK, STEPHANIE PAIGE (LICSW)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:PAIGE
Last Name:FREDERICK
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2227 DRAKE AVE SW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35805-5199
Mailing Address - Country:US
Mailing Address - Phone:256-881-1311
Mailing Address - Fax:
Practice Address - Street 1:2227 DRAKE AVE SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35805-5199
Practice Address - Country:US
Practice Address - Phone:256-881-1311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5814C101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)