Provider Demographics
NPI:1447745609
Name:STEVENSON, AVA LAVERNE (MA, LACS-A)
Entity Type:Individual
Prefix:
First Name:AVA
Middle Name:LAVERNE
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:MA, LACS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2313 TALON DR
Mailing Address - Street 2:
Mailing Address - City:MC LEANSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27301-3001
Mailing Address - Country:US
Mailing Address - Phone:336-988-8206
Mailing Address - Fax:
Practice Address - Street 1:2313 TALON DR
Practice Address - Street 2:
Practice Address - City:MC LEANSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27301-3001
Practice Address - Country:US
Practice Address - Phone:336-988-8206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2501101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty