Provider Demographics
NPI:1922854512
Name:STEPHENSON, SARA MCKENZIE (CADC-I)
Entity type:Individual
Prefix:MISS
First Name:SARA
Middle Name:MCKENZIE
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:CADC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2840 SANDESTIN DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523-2135
Mailing Address - Country:US
Mailing Address - Phone:775-800-1136
Mailing Address - Fax:
Practice Address - Street 1:205 S PRATT AVE
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89701-4730
Practice Address - Country:US
Practice Address - Phone:775-882-3945
Practice Address - Fax:775-882-6126
Is Sole Proprietor?:No
Enumeration Date:2024-04-25
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV07482-I101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)