Provider Demographics
NPI:1518262187
Name:STEVENS, MICHELLE G (LISW)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:G
Last Name:STEVENS
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 WALNUT LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-8610
Mailing Address - Country:US
Mailing Address - Phone:803-446-2316
Mailing Address - Fax:
Practice Address - Street 1:228 WALNUT LN
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-8610
Practice Address - Country:US
Practice Address - Phone:803-446-2316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-12
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC46181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical