Healthcare Provider Details

I. General information

NPI: 1639635428
Provider Name (Legal Business Name): VIERRE STEVENSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2019
Last Update Date: 11/08/2022
Certification Date: 11/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21000 PLUMMER ST
CHATSWORTH CA
91311-4903
US

IV. Provider business mailing address

21000 PLUMMER ST
CHATSWORTH CA
91311-4903
US

V. Phone/Fax

Practice location:
  • Phone: 818-882-6400
  • Fax:
Mailing address:
  • Phone: 818-882-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number111391
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: