Provider Demographics
NPI:1003689241
Name:STOVALL, SAMARIA DENEICE YVETTE
Entity Type:Individual
Prefix:
First Name:SAMARIA
Middle Name:DENEICE YVETTE
Last Name:STOVALL
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 1:1379 S ULSTER ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-2743
Mailing Address - Country:US
Mailing Address - Phone:303-898-0200
Mailing Address - Fax:
Practice Address - Street 1:1820 S JOLIET ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-5030
Practice Address - Country:US
Practice Address - Phone:720-747-3300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor