Provider Demographics
NPI:1235865080
Name:STEVENSON, MILDRED MCCALL (RBT)
Entity Type:Individual
Prefix:
First Name:MILDRED
Middle Name:MCCALL
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 80901
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29416-0901
Mailing Address - Country:US
Mailing Address - Phone:706-664-8713
Mailing Address - Fax:888-808-4249
Practice Address - Street 1:1820 1ST DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-5756
Practice Address - Country:US
Practice Address - Phone:706-664-8713
Practice Address - Fax:888-808-4249
Is Sole Proprietor?:No
Enumeration Date:2022-07-25
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician