Healthcare Provider Details

I. General information

NPI: 1871404152
Provider Name (Legal Business Name): YVONNE WHITE STEVENSON PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6285 EMERALD POINTE CIR
COLLEGE PARK GA
30349-4894
US

IV. Provider business mailing address

6285 EMERALD POINTE CIR
COLLEGE PARK GA
30349-4894
US

V. Phone/Fax

Practice location:
  • Phone: 770-256-6864
  • Fax: 770-997-5474
Mailing address:
  • Phone: 770-256-6864
  • Fax: 770-997-5474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number039382074
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: