Provider Demographics
NPI:1285724666
Name:STEVENSON, KEVIN RICKS (LMSW-C, BCD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:RICKS
Last Name:STEVENSON
Suffix:
Gender:M
Credentials:LMSW-C, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1061 HARMON AVENUE BUILDING
Mailing Address - Street 2:WINN ARMY COMMUNITY HOSPITAL
Mailing Address - City:FORT STEWART
Mailing Address - State:GA
Mailing Address - Zip Code:31314-5674
Mailing Address - Country:US
Mailing Address - Phone:912-435-6779
Mailing Address - Fax:
Practice Address - Street 1:1061 HARMON AVENUE BUILDING 311
Practice Address - Street 2:WINN ARMY COMMUNITY HOSPITAL
Practice Address - City:FORT STEWART
Practice Address - State:GA
Practice Address - Zip Code:31314-5674
Practice Address - Country:US
Practice Address - Phone:912-435-6779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010805491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAVAD 000Medicare UPIN