Provider Demographics
NPI:1194238618
Name:STEVENSON, ROSE A (LCPA)
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:A
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:LCPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 THEO DR
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-8543
Mailing Address - Country:US
Mailing Address - Phone:919-583-1733
Mailing Address - Fax:
Practice Address - Street 1:1420A S POLLOCK ST
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:NC
Practice Address - Zip Code:27576-3404
Practice Address - Country:US
Practice Address - Phone:919-351-0428
Practice Address - Fax:919-351-0814
Is Sole Proprietor?:No
Enumeration Date:2017-11-06
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA13475101YP2500X
NC13475101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional