Provider Demographics
NPI:1285057869
Name:STEVENSON, ANDREW JORDAN (MA, CAGS, LMHC, LCDP)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:JORDAN
Last Name:STEVENSON
Suffix:
Gender:M
Credentials:MA, CAGS, LMHC, LCDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 PUTNAM PIKE STE 7
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:RI
Mailing Address - Zip Code:02828-1487
Mailing Address - Country:US
Mailing Address - Phone:401-949-2220
Mailing Address - Fax:
Practice Address - Street 1:600 PUTNAM PIKE STE 7
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:RI
Practice Address - Zip Code:02828-1487
Practice Address - Country:US
Practice Address - Phone:401-949-2220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-02
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00742101YM0800X
RICDP00598101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)