Provider Demographics
NPI:1225899156
Name:STEVENS, TERRENCE (LCDC)
Entity Type:Individual
Prefix:
First Name:TERRENCE
Middle Name:
Last Name:STEVENS
Suffix:
Gender:M
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1841 RIVER RUN DR
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-0101
Mailing Address - Country:US
Mailing Address - Phone:972-277-7545
Mailing Address - Fax:
Practice Address - Street 1:1841 RIVER RUN DR
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-0101
Practice Address - Country:US
Practice Address - Phone:972-277-7545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14855101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)