Healthcare Provider Details

I. General information

NPI: 1902993348
Provider Name (Legal Business Name): STEVENS HEALTHCARE AGENCY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 09/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 GUM BRANCH RD STE N
JACKSONVILLE NC
28540-6269
US

IV. Provider business mailing address

824 GUM BRANCH RD STE N
JACKSONVILLE NC
28540-6269
US

V. Phone/Fax

Practice location:
  • Phone: 910-938-7200
  • Fax: 910-938-7201
Mailing address:
  • Phone: 910-938-7200
  • Fax: 910-938-7201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1206
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7145
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC004946
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. LINDA FREEMAN STEVENS
Title or Position: PRESIDENT
Credential:
Phone: 910-938-7200