Provider Demographics
NPI:1558782987
Name:STEPHENSON, MARLA (BA)
Entity Type:Individual
Prefix:
First Name:MARLA
Middle Name:
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 RESERVOIR RD APT 205
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72227-4929
Mailing Address - Country:US
Mailing Address - Phone:870-210-6385
Mailing Address - Fax:
Practice Address - Street 1:1901 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114-2831
Practice Address - Country:US
Practice Address - Phone:501-955-2674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-03
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator