Provider Demographics
NPI:1003807611
Name:DETERS, STEVEN HAROLD (PHD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:HAROLD
Last Name:DETERS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 HAWTHORNE RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-9780
Mailing Address - Country:US
Mailing Address - Phone:252-752-5394
Mailing Address - Fax:
Practice Address - Street 1:3485 S EVANS ST
Practice Address - Street 2:STE A
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-4532
Practice Address - Country:US
Practice Address - Phone:252-353-6277
Practice Address - Fax:252-353-6511
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1318103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0351HOtherBLUE CROSS BLUE SHIELD