Healthcare Provider Details

I. General information

NPI: 1285558973
Provider Name (Legal Business Name): BRUCE DAVID STEVENS JR. APC, NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1318 BREWSTER ST SW
ATLANTA GA
30310-4022
US

IV. Provider business mailing address

1318 BREWSTER ST SW
ATLANTA GA
30310-4022
US

V. Phone/Fax

Practice location:
  • Phone: 404-388-3262
  • Fax:
Mailing address:
  • Phone: 404-388-3262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPC011141
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: