Provider Demographics
NPI:1538677695
Name:STEVENSON, JAMES HARRY (CSC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:HARRY
Last Name:STEVENSON
Suffix:
Gender:M
Credentials:CSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 DEFENSE ST STE 100
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3578
Mailing Address - Country:US
Mailing Address - Phone:443-214-5097
Mailing Address - Fax:
Practice Address - Street 1:34 DEFENSE ST STE 100
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3578
Practice Address - Country:US
Practice Address - Phone:443-214-5097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-11
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDSC2290101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)