| Doctor Name: | STEPHANIE PUCKETT |
| NPI Number: | 1114328077 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPCA |
| License Number: | A11005 |
| Business Practice Address: | 414 W Lebanon St Mount Airy, NC - 270302954 |
| Business Phone Number: | 3367899492 |
| Business Fax Number: | 3367899587 |
| Mailing Address: | 414 W Lebanon St, MOUNT AIRY |
| State: | NC |
| Postal Code: | 270302954 |
| Phone Number: | 3367899492 |
| Fax Number: | 3367899587 |
| NPI Enumeration Date: | 09/10/2014 |
| NPI Last Update Date: | 09/10/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | A11005 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |