Provider Demographics
NPI:1679920011
Name:HOPRICH, STEPHAN JR (BCABA, LABA)
Entity type:Individual
Prefix:
First Name:STEPHAN
Middle Name:
Last Name:HOPRICH
Suffix:JR
Gender:M
Credentials:BCABA, LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 KINGS CREST DR
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-5114
Mailing Address - Country:US
Mailing Address - Phone:570-417-7611
Mailing Address - Fax:
Practice Address - Street 1:1630 BRAEBURN DR
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-7371
Practice Address - Country:US
Practice Address - Phone:540-588-9582
Practice Address - Fax:540-387-0347
Is Sole Proprietor?:No
Enumeration Date:2016-05-16
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0134000154103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst