Provider Demographics
NPI:1285414508
Name:STEPHENS, CORONA LEE JR (DC)
Entity type:Individual
Prefix:MR
First Name:CORONA
Middle Name:LEE
Last Name:STEPHENS
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 MORRIS RD SE APT 402
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-5244
Mailing Address - Country:US
Mailing Address - Phone:202-704-4451
Mailing Address - Fax:
Practice Address - Street 1:1360 MORRIS RD SE APT 402
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-5244
Practice Address - Country:US
Practice Address - Phone:202-704-4451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker