Provider Demographics
NPI:1043741606
Name:SWANZETTA J. STEVENSON,LCSW,PLLC
Entity Type:Organization
Organization Name:SWANZETTA J. STEVENSON,LCSW,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SWANZETTA
Authorized Official - Middle Name:JOHNSON
Authorized Official - Last Name:STEVENSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:252-548-1510
Mailing Address - Street 1:100 VALLEY STREAM RD
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:NC
Mailing Address - Zip Code:28390-2875
Mailing Address - Country:US
Mailing Address - Phone:252-548-1510
Mailing Address - Fax:
Practice Address - Street 1:319 COURT SQ
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-5658
Practice Address - Country:US
Practice Address - Phone:252-548-1510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-24
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC008540251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health