Provider Demographics
NPI:1497290373
Name:STEVENS, HEATHER BREANNE (MS)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:BREANNE
Last Name:STEVENS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:BREANNE
Other - Middle Name:
Other - Last Name:STEVENS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:890 JOHNNIE DODDS BLVD UNIT 3
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-6129
Mailing Address - Country:US
Mailing Address - Phone:843-884-3888
Mailing Address - Fax:
Practice Address - Street 1:6401 S US HIGHWAY 41
Practice Address - Street 2:GIBAULT CARE, INC.
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-4749
Practice Address - Country:US
Practice Address - Phone:812-299-1156
Practice Address - Fax:812-299-0118
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-30
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8142101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional