Provider Demographics
NPI:1003240391
Name:STEVENS, DONNA
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:STEVENS
Suffix:
Gender:F
Credentials:
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 3285
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-1285
Mailing Address - Country:US
Mailing Address - Phone:310-489-8140
Mailing Address - Fax:
Practice Address - Street 1:24050 MADISON ST STE 108
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-6016
Practice Address - Country:US
Practice Address - Phone:310-489-8140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-22
Last Update Date:2020-01-03
Deactivation Date:2019-12-03
Deactivation Code:
Reactivation Date:2019-12-11
Provider Licenses
StateLicense IDTaxonomies
CA116590106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist