Provider Demographics
NPI:1396105953
Name:STEVENS, ROBERT LAKE (LPC, LCDC-III, CRC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:LAKE
Last Name:STEVENS
Suffix:
Gender:M
Credentials:LPC, LCDC-III, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 E 2ND ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-2593
Mailing Address - Country:US
Mailing Address - Phone:740-851-5307
Mailing Address - Fax:740-851-5308
Practice Address - Street 1:126 E 2ND ST
Practice Address - Street 2:SUITE B
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-2593
Practice Address - Country:US
Practice Address - Phone:740-851-5307
Practice Address - Fax:740-851-5308
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-25
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH151184101YA0400X
OHC1400272101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)