Healthcare Provider Details

I. General information

NPI: 1508258542
Provider Name (Legal Business Name): SHA'VONYA M STEPHENS LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2015
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 S LAUREL ST
PINE BLUFF AR
71601-4859
US

IV. Provider business mailing address

620 S LAUREL ST
PINE BLUFF AR
71601-4859
US

V. Phone/Fax

Practice location:
  • Phone: 870-534-4900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateZZ
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1361
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: