Stefanie E. Petyak, MA, LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

1483 Issued in NC

Practice address

432 S Main St Ste 200
Davidson, NC 28036-8130

Phone

(980) 219-2697

NPI assigned

Apr 7, 2008

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Flyleaf Counseling, PLLC

  • Clinical Social Worker
  • Davidson, NC
  • NPI 1588151328

  Marriage & Family Therapist

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1207526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1720251176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "432 S MAIN ST STE 200",
            "city": "DAVIDSON",
            "state": "NC",
            "postal_code": "280368130",
            "telephone_number": "980-219-2697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "432 S MAIN ST STE 200",
            "city": "DAVIDSON",
            "state": "NC",
            "postal_code": "280368130",
            "telephone_number": "980-219-2697"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1923 J N Pease Pl",
            "address_2": "104",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282624513",
            "country_code": "US",
            "telephone_number": "704-733-9700",
            "fax_number": "704-733-9298",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETYAK",
        "first_name": "STEFANIE",
        "middle_name": "E.",
        "credential": "MA, LMFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-04-07",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "HI",
            "license": "MFT 180",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NC",
            "license": "7052A",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NC",
            "license": "1483",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Donna Teresa Ordon Ippolito, MA
• Heather Nicole Page, MSW, LCSW
• Deborah Bryan Parrott, MSW, LCSW, RYT
• Yogesh K Patel, MD
• Christine Personett
• Physiofit Physical Therapy and Sports Performance LLC
• Leslie Laughlin Pitt, LMFTA
• Juan Pizarro
• Alexandru Paul Popa, LCMHCA
• Mallorie Porter, RN, IBCLC

• Marriage & Family Therapist in Davidson, NC
• Providers in Davidson, NC by specialty
• Marriage & Family Therapist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.