Provider Demographics
NPI:1972267680
Name:STEVENS, SUSAN KELLEY (MSC, LCAS-A)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:KELLEY
Last Name:STEVENS
Suffix:
Gender:F
Credentials:MSC, LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 351
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27023-0351
Mailing Address - Country:US
Mailing Address - Phone:336-624-0935
Mailing Address - Fax:
Practice Address - Street 1:2199 CODDLE CREEK HWY
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-8250
Practice Address - Country:US
Practice Address - Phone:336-624-0935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-28
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27742101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)