Individual
ANGEL STEVENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CT
Contact information
Practice address
2550 LAWLOR RD, FAIRBANKS, AK 99709-6458
(907) 455-4725
(907) 455-4730
Mailing address
PO BOX 72258, FAIRBANKS, AK 99707-2258
(907) 452-7221
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CERTIFICATE 3215
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DA4437
—
AK
Enumeration date
06/18/2007
Last updated
07/09/2007
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