Provider Demographics
NPI:1922796010
Name:STEVENSON, JEROME PRITCHARD SR (LPC)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:PRITCHARD
Last Name:STEVENSON
Suffix:SR
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6336 CHERI LYNNE DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-2109
Mailing Address - Country:US
Mailing Address - Phone:937-245-2857
Mailing Address - Fax:
Practice Address - Street 1:6336 CHERI LYNNE DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-2109
Practice Address - Country:US
Practice Address - Phone:937-245-2857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC1000316101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional