Provider Demographics
NPI:1902589179
Name:STEVENS, ELENA (MA, LPC)
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:STEVENS
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3205 OLD ROBIN ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-1926
Mailing Address - Country:US
Mailing Address - Phone:970-275-3719
Mailing Address - Fax:
Practice Address - Street 1:9720 CAPITAL CT
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-2044
Practice Address - Country:US
Practice Address - Phone:703-881-0121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701012695101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional