Provider Demographics
NPI:1457951741
Name:STEVENSON, SAMANDA M (LCAS, CSI,LCMHC, NCC)
Entity type:Individual
Prefix:
First Name:SAMANDA
Middle Name:M
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:LCAS, CSI,LCMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7120 MARICOPA RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-3577
Mailing Address - Country:US
Mailing Address - Phone:980-475-3643
Mailing Address - Fax:
Practice Address - Street 1:10348 PARK RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-8507
Practice Address - Country:US
Practice Address - Phone:704-288-1097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25970101YA0400X
NC16240101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)