Provider Demographics
NPI:1124283650
Name:STEVENS, JAMILA MACA-ELAINE (MSW)
Entity type:Individual
Prefix:
First Name:JAMILA
Middle Name:MACA-ELAINE
Last Name:STEVENS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7375 WOODWARD AVE
Mailing Address - Street 2:#1570
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-3158
Mailing Address - Country:US
Mailing Address - Phone:313-309-1479
Mailing Address - Fax:313-309-1476
Practice Address - Street 1:7375 WOODWARD AVE
Practice Address - Street 2:#1570
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-3158
Practice Address - Country:US
Practice Address - Phone:313-309-1479
Practice Address - Fax:313-309-1476
Is Sole Proprietor?:No
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010860951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical