Individual
KIPPI LILLY STEVENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, CSAC, TCM
Contact information
Practice address
103 S BRADY ST, RAMSEUR, NC 27316-9538
(336) 824-1735
Mailing address
103 S BRADY ST, RAMSEUR, NC 27316-9538
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
171M00000X
Case Manager/Care Coordinator
—
—
172V00000X
Community Health Worker
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
82-4857945
SUBSTANCE ABUSE
—
Enumeration date
03/21/2018
Last updated
03/21/2018
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