Provider Demographics
NPI:1851861611
Name:STEVENSON, COREY M (RBT)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:M
Last Name:STEVENSON
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 1ST AVE APT B102
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-7591
Mailing Address - Country:US
Mailing Address - Phone:706-341-5910
Mailing Address - Fax:
Practice Address - Street 1:3201 1ST AVE APT B102
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-7591
Practice Address - Country:US
Practice Address - Phone:706-341-5910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-04
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst