Provider Demographics
NPI:1033371315
Name:STEVENS, SHERRIE ANNASTACIA (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SHERRIE
Middle Name:ANNASTACIA
Last Name:STEVENS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 N NEVADA AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-1073
Mailing Address - Country:US
Mailing Address - Phone:719-301-5449
Mailing Address - Fax:
Practice Address - Street 1:611 N NEVADA AVE STE 1
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-1073
Practice Address - Country:US
Practice Address - Phone:719-301-5449
Practice Address - Fax:719-434-9913
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-27
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO03894971041S0200X
CO11341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool