MEDICARE: DINA STEVENS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1184127938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DINA STEVENS

Provider Business Mailing Address
First Line	:	300 INTERNATIONAL PKWY STE 200
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-5028
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	296 MERCHANTS SQ
Second Line	:
City	:	DALLAS
State	:	GA
Zip	:	30132-5029
Country	:	US
Telephone Number	:	470-391-2300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2018
Last Update Date	:	03/03/2026

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Directions to “ DINA STEVENS ” Practice Location

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