Healthcare Provider Details

I. General information

NPI: 1326530429
Provider Name (Legal Business Name): SALLY STEVENS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2018
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10331 STANFORD AVE
GARDEN GROVE CA
92840-6351
US

IV. Provider business mailing address

16897 ALGONQUIN ST STE L
HUNTINGTON BEACH CA
92649-3832
US

V. Phone/Fax

Practice location:
  • Phone: 714-663-6000
  • Fax:
Mailing address:
  • Phone: 213-241-3841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number82459
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: