MEDICARE: ALTHERIA M. STEVENS M.S.

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	103TS0200X	School Psychologist	PPS-06001341	VA

General Provider Information

NPI Number	:	1952542938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALTHERIA M. STEVENS M.S.

Provider Business Mailing Address
First Line	:	4113 LAWNWOOD DRIVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23234
Country	:	US
Telephone Number	:	804-926-4968
Fax Number	:

Provider Business Practice Location Address
First Line	:	4113 LAWNWOOD DR
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23234-5549
Country	:	US
Telephone Number	:	804-926-4968
Fax Number	:

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

Provider Enumeration Date	:	03/20/2009
Last Update Date	:	03/20/2009

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