Provider Demographics
NPI:1871918193
Name:STINE, THERESA (LPC)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:STINE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 JEFFERSON HEIGHTS AVE
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:LA
Mailing Address - Zip Code:70121-3209
Mailing Address - Country:US
Mailing Address - Phone:504-813-4564
Mailing Address - Fax:
Practice Address - Street 1:6321 STRATFORD PL
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70131-7325
Practice Address - Country:US
Practice Address - Phone:504-252-9015
Practice Address - Fax:504-252-9621
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-24
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
LA4234101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty