Provider Demographics
NPI:1285399923
Name:STEVENS, MANIYA (BS)
Entity type:Individual
Prefix:
First Name:MANIYA
Middle Name:
Last Name:STEVENS
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 LEE AVE
Mailing Address - Street 2:
Mailing Address - City:DANIELS
Mailing Address - State:WV
Mailing Address - Zip Code:25832-9123
Mailing Address - Country:US
Mailing Address - Phone:304-673-2545
Mailing Address - Fax:
Practice Address - Street 1:1289 ROBERT C BYRD DRIVE
Practice Address - Street 2:SUITE 4
Practice Address - City:CRAB ORCHARD
Practice Address - State:WV
Practice Address - Zip Code:25827
Practice Address - Country:US
Practice Address - Phone:304-253-8979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator