Provider Demographics
NPI:1104316918
Name:STEVENS, ELIZABETH ANN (MED)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:STEVENS
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13454 SUNRISE VALLEY DR STE 230
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-3279
Mailing Address - Country:US
Mailing Address - Phone:703-464-0989
Mailing Address - Fax:
Practice Address - Street 1:13454 SUNRISE VALLEY DR STE 250
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-3278
Practice Address - Country:US
Practice Address - Phone:703-464-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health