Provider Demographics
NPI:1346880747
Name:STEVENS, TYLAH VICTORIA (LICSW, LCSW-C)
Entity Type:Individual
Prefix:MRS
First Name:TYLAH
Middle Name:VICTORIA
Last Name:STEVENS
Suffix:
Gender:F
Credentials:LICSW, LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3261 OLD WASHINGTON RD STE 3021
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-3229
Mailing Address - Country:US
Mailing Address - Phone:240-280-3245
Mailing Address - Fax:
Practice Address - Street 1:3261 OLD WASHINGTON RD STE 3021
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-3229
Practice Address - Country:US
Practice Address - Phone:240-280-3245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-14
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040114561041C0700X
DCLC500818421041C0700X
MD247951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical