Healthcare Provider Details

I. General information

NPI: 1790907012
Provider Name (Legal Business Name): STEPHANIE STEVENS MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 OAKMOUND RD
CLARKSBURG WV
26301-9398
US

IV. Provider business mailing address

306 BUCKHANNON PIKE
NUTTER FORT WV
26301-3900
US

V. Phone/Fax

Practice location:
  • Phone: 304-622-7511
  • Fax:
Mailing address:
  • Phone: 304-622-0525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number00085368
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: