Provider Demographics
NPI:1174155675
Name:RADOSEVICH, STEPHEN SCOTT (MA, LCMHC, NCC)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:SCOTT
Last Name:RADOSEVICH
Suffix:
Gender:M
Credentials:MA, LCMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 460
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28570-0460
Mailing Address - Country:US
Mailing Address - Phone:252-777-2016
Mailing Address - Fax:
Practice Address - Street 1:209 N 35TH ST STE B3
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-3183
Practice Address - Country:US
Practice Address - Phone:252-777-2016
Practice Address - Fax:252-656-2624
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-12
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA15560101YM0800X
NC15560101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty