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General NPI Number Information
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NPI Number | 1124489786
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Entity Type | Individual
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Provider Name | DR. MICHELLE STEVENS
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Gender | Female
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Dates
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Enumeration Date | 03/10/2016
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Last Update Date | 03/09/2024
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Provider Practice Location Address
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Address Line | 631 STICKLEY RD
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City | COLUMBIA
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State | SC
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Zip | 29229-6889
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Country | US
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Telephone | 301-875-6567
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Fax |
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Provider Business Mailing Address
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Address Line | 631 STICKLEY RD
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City | COLUMBIA
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State | SC
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Zip | 29229-6889
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Country | US
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Telephone | 130-187-5656
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number | D14115-27
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 13459
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | RO2162
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License Number State | MD
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | R02162
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License Number State | MD
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