Healthcare Provider Details

I. General information

NPI: 1891118808
Provider Name (Legal Business Name): STEPHANIE NEVIN PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2014
Last Update Date: 06/22/2020
Certification Date: 06/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1206 LASKIN RD STE 201G
VIRGINIA BEACH VA
23451-5263
US

IV. Provider business mailing address

1206 LASKIN RD STE 201G
VIRGINIA BEACH VA
23451-5263
US

V. Phone/Fax

Practice location:
  • Phone: 757-620-8545
  • Fax:
Mailing address:
  • Phone: 757-620-8545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number14-04P
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810006149
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: