Individual
MARY S STEVENS
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1000 COMMERCIAL LN, WTCSB, SUFFOLK, VA 23434-8148
(757) 942-1069
(757) 925-2213
Mailing address
1000 COMMERCIAL LN, WTCSB, SUFFOLK, VA 23434-8148
(757) 942-1069
(757) 925-2213
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0904002094
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
270371
TRIGONBC/BS HEALTHKEEPERS
VA
05
—
8904766
—
VA
01
—
O83006
OPITMA FAMILY CARE
VA
Enumeration date
09/16/2005
Last updated
07/08/2007
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