Provider Demographics
NPI:1427471192
Name:STEPHENSON, DAVID (LGSW)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:STEPHENSON
Suffix:
Gender:M
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8818 GEORGIA AVE
Mailing Address - Street 2:CHILD ADOLESCENT BEHAVIORAL SERVICES
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-2713
Mailing Address - Country:US
Mailing Address - Phone:240-777-4416
Mailing Address - Fax:
Practice Address - Street 1:8818 GEORGIA AVE
Practice Address - Street 2:CHILD ADOLESCENT BEHAVIORAL SERVICES
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-2713
Practice Address - Country:US
Practice Address - Phone:240-777-4416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-30
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17118104100000X
DCLG50079608104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker