Provider Demographics
NPI:1033450317
Name:STEVENSON PSYCHOLOGICAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:STEVENSON PSYCHOLOGICAL ASSOCIATES LLC
Other - Org Name:COLUMBIA MENTAL HEALTH RESOURCES INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:STEVENSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:410-905-4763
Mailing Address - Street 1:6755 BUSINESS PKWY
Mailing Address - Street 2:SUITE 402
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-6753
Mailing Address - Country:US
Mailing Address - Phone:410-796-4742
Mailing Address - Fax:410-796-4729
Practice Address - Street 1:6755 BUSINESS PKWY
Practice Address - Street 2:SUITE 402
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-6753
Practice Address - Country:US
Practice Address - Phone:410-796-4742
Practice Address - Fax:410-796-4729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-11
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01842103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty