Provider Demographics
NPI:1710414503
Name:STEVENSON, VICKI LYNN (LMSW)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:LYNN
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2075 S COTTONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-3040
Mailing Address - Country:US
Mailing Address - Phone:480-718-0568
Mailing Address - Fax:
Practice Address - Street 1:2075 S COTTONWOOD DR
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-3040
Practice Address - Country:US
Practice Address - Phone:480-718-0568
Practice Address - Fax:480-999-4102
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-16622104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker