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General NPI Number Information
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NPI Number | 1629446760
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Entity Type | Individual
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Provider Name | JACRISSA S. STEVENSON LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/07/2015
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Last Update Date | 11/20/2022
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Provider Practice Location Address
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Address Line | 4750 HARTLAND PKWY STE 248
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City | LEXINGTON
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State | KY
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Zip | 40515-1561
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Country | US
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Telephone | 859-436-9618
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Fax | 859-201-1361
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Provider Business Mailing Address
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Address Line | 1152 STONECROP DR
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City | LEXINGTON
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State | KY
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Zip | 40509-9054
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Country | US
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Telephone | 859-533-4470
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 7345
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 254354
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License Number State | KY
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