Provider Demographics
NPI:1871744722
Name:REI, STEPHANIE JO (LCSW-BACS, C-SSWS)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JO
Last Name:REI
Suffix:
Gender:
Credentials:LCSW-BACS, C-SSWS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:539 DOGWOOD SOUTH LN
Mailing Address - Street 2:
Mailing Address - City:HAUGHTON
Mailing Address - State:LA
Mailing Address - Zip Code:71037-8554
Mailing Address - Country:US
Mailing Address - Phone:318-540-8576
Mailing Address - Fax:
Practice Address - Street 1:539 DOGWOOD SOUTH LN
Practice Address - Street 2:
Practice Address - City:HAUGHTON
Practice Address - State:LA
Practice Address - Zip Code:71037-8554
Practice Address - Country:US
Practice Address - Phone:318-540-8576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK280429171M00000X
LA145651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
33-2957479OtherAWAKENING GRACE THERAPY LLC