Provider Demographics
NPI:1346959467
Name:STEVENS, RONDA LYNN (PHD, MS, BS, MHP)
Entity Type:Individual
Prefix:
First Name:RONDA
Middle Name:LYNN
Last Name:STEVENS
Suffix:
Gender:F
Credentials:PHD, MS, BS, MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 RIVER TREE CIR
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-8211
Mailing Address - Country:US
Mailing Address - Phone:760-608-0790
Mailing Address - Fax:
Practice Address - Street 1:77 HAZZARD CREEK VLG # VILLAGEC
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:SC
Practice Address - Zip Code:29936-8266
Practice Address - Country:US
Practice Address - Phone:843-645-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC15688907OtherCAQH