Provider Demographics
NPI:1689160707
Name:DURHAM, STEPHANIE JAN (LPCC-S)
Entity type:Individual
Prefix:MISS
First Name:STEPHANIE
Middle Name:JAN
Last Name:DURHAM
Suffix:
Gender:F
Credentials:LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6601 CENTERVILLE BUSINESS PKWY STE 310
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-2697
Mailing Address - Country:US
Mailing Address - Phone:937-739-6149
Mailing Address - Fax:937-963-0961
Practice Address - Street 1:6601 CENTERVILLE BUSINESS PKWY STE 310
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-2697
Practice Address - Country:US
Practice Address - Phone:937-739-6149
Practice Address - Fax:937-963-0961
Is Sole Proprietor?:No
Enumeration Date:2018-07-02
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.2102577-SUPV101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health