Provider Demographics
NPI:1043734692
Name:GARNHAM, STEVEN S (LEAP, CADC)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:S
Last Name:GARNHAM
Suffix:
Gender:M
Credentials:LEAP, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 VALLEY GLEN RD
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-1719
Mailing Address - Country:US
Mailing Address - Phone:267-237-3008
Mailing Address - Fax:215-689-2990
Practice Address - Street 1:325 CHESTNUT ST STE 879
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19106-2614
Practice Address - Country:US
Practice Address - Phone:267-237-3008
Practice Address - Fax:215-689-2990
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-26
Last Update Date:2017-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC157101Y00000X
PA2369101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor