Provider Demographics
NPI:1629793112
Name:STEVENS, CLARRISSA A (LCMHC)
Entity Type:Individual
Prefix:
First Name:CLARRISSA
Middle Name:A
Last Name:STEVENS
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:CLARE
Other - Middle Name:A
Other - Last Name:STEVENS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCMHC
Mailing Address - Street 1:PO BOX 647
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05601-0647
Mailing Address - Country:US
Mailing Address - Phone:802-229-0591
Mailing Address - Fax:802-223-3667
Practice Address - Street 1:286 HOSPITAL LOOP
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:VT
Practice Address - Zip Code:05602-9523
Practice Address - Country:US
Practice Address - Phone:802-229-0591
Practice Address - Fax:802-223-3667
Is Sole Proprietor?:No
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0134874101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health