Healthcare Provider Details

I. General information

NPI: 1922488600
Provider Name (Legal Business Name): MICHELLE C STEVENS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE C DEVINCENTIS

II. Dates (important events)

Enumeration Date: 06/08/2015
Last Update Date: 01/10/2026
Certification Date: 01/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 592
GRAY ME
04039-0592
US

IV. Provider business mailing address

PO BOX 592
GRAY ME
04039-0592
US

V. Phone/Fax

Practice location:
  • Phone: 626-461-9295
  • Fax:
Mailing address:
  • Phone: 626-461-9295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number100.0134433
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number115286
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMF7716
License Number StateME
# 4
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: