Provider Demographics
NPI:1467937730
Name:STEPHENS, JONATHAN CHRISTIAN
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:CHRISTIAN
Last Name:STEPHENS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 EXECUTIVE DR STE C
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-6604
Mailing Address - Country:US
Mailing Address - Phone:757-827-7707
Mailing Address - Fax:
Practice Address - Street 1:638 INDEPENDENCE PKWY STE 240
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-5222
Practice Address - Country:US
Practice Address - Phone:757-965-5886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-02
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA117272106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist