Provider Demographics
NPI:1942537147
Name:STEVENS, JACKI C (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JACKI
Middle Name:C
Last Name:STEVENS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1661 E CHAPMAN AVE
Mailing Address - Street 2:SUITE 1-E
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-4061
Mailing Address - Country:US
Mailing Address - Phone:951-444-8490
Mailing Address - Fax:909-590-4146
Practice Address - Street 1:1661 E CHAPMAN AVE
Practice Address - Street 2:SUITE 1-E
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-4061
Practice Address - Country:US
Practice Address - Phone:951-444-8490
Practice Address - Fax:909-590-4146
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-09
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS256581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical