Provider Demographics
NPI:1073974689
Name:STEVENS, CATHERINE THIRSK
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:THIRSK
Last Name:STEVENS
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 1:1403 DOUGLAS DR
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:39819-5176
Mailing Address - Country:US
Mailing Address - Phone:229-254-0354
Mailing Address - Fax:
Practice Address - Street 1:1403 DOUGLAS DR
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:39819-5176
Practice Address - Country:US
Practice Address - Phone:229-254-0354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-09
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator