Healthcare Provider Details

I. General information

NPI: 1346959467
Provider Name (Legal Business Name): RONDA LYNN STEVENS PHD, MS, BS, MHP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2022
Last Update Date: 11/17/2022
Certification Date: 11/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 HAZZARD CREEK VLG # VILLAGEC
RIDGELAND SC
29936-8266
US

IV. Provider business mailing address

57 RIVER TREE CIR
BLUFFTON SC
29910-8211
US

V. Phone/Fax

Practice location:
  • Phone: 843-645-7700
  • Fax:
Mailing address:
  • Phone: 760-608-0790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: