Provider Demographics
NPI:1861165540
Name:STEPHENS, PATRICIA E (CDCA #175192)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:E
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:CDCA #175192
Other - Prefix:MS
Other - First Name:PATTY
Other - Middle Name:ETUE
Other - Last Name:STEPHENS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1738 BROOKLYNN PARK EAST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615
Mailing Address - Country:US
Mailing Address - Phone:419-320-3699
Mailing Address - Fax:
Practice Address - Street 1:JOSHUA TREATMENT CENTER
Practice Address - Street 2:350 SIRWIN RD
Practice Address - City:HOLLAND
Practice Address - State:OH
Practice Address - Zip Code:43528-0301
Practice Address - Country:US
Practice Address - Phone:567-703-9064
Practice Address - Fax:419-222-7044
Is Sole Proprietor?:No
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH175192101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)