Provider Demographics
NPI:1275167520
Name:STEVENS, KALYN J (CADC)
Entity Type:Individual
Prefix:
First Name:KALYN
Middle Name:J
Last Name:STEVENS
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:KALYN
Other - Middle Name:
Other - Last Name:OTTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CADC
Mailing Address - Street 1:180 ACADEMY ST STE 3
Mailing Address - Street 2:
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04769-3183
Mailing Address - Country:US
Mailing Address - Phone:207-554-2352
Mailing Address - Fax:207-554-2351
Practice Address - Street 1:14 STEVES LN
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:ME
Practice Address - Zip Code:04654-5045
Practice Address - Country:US
Practice Address - Phone:207-255-0996
Practice Address - Fax:207-255-8748
Is Sole Proprietor?:No
Enumeration Date:2020-02-26
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC7134101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor