Provider Demographics
NPI:1124489786
Name:STEVENS, MICHELLE
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:
Last Name:STEVENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 STICKLEY RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-6889
Mailing Address - Country:US
Mailing Address - Phone:130-187-5656
Mailing Address - Fax:
Practice Address - Street 1:631 STICKLEY RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-6889
Practice Address - Country:US
Practice Address - Phone:301-875-6567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-10
Last Update Date:2024-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD14115-27101YP1600X
SC13459225700000X
MDRO2162225700000X
MDR02162101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist