Healthcare Provider Details

I. General information

NPI: 1184270951
Provider Name (Legal Business Name): JUDITH MARIE STEVERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2019
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 UNIONVILLE INDIAN TRAIL RD W STE C100
INDIAN TRAIL NC
28079-5670
US

IV. Provider business mailing address

13663 PROVIDENCE RD # 355
WEDDINGTON NC
28104-9373
US

V. Phone/Fax

Practice location:
  • Phone: 704-438-9901
  • Fax:
Mailing address:
  • Phone: 704-258-0405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC013819
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: