Provider Demographics
NPI:1023127735
Name:STEVENSON, VICTOR EMMANUEL (PHD)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:EMMANUEL
Last Name:STEVENSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 STAPLETON RD
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31216-5233
Mailing Address - Country:US
Mailing Address - Phone:478-477-9143
Mailing Address - Fax:
Practice Address - Street 1:655 7TH STREET, BLDG 704
Practice Address - Street 2:78TH MDG
Practice Address - City:ROBINS AFB
Practice Address - State:GA
Practice Address - Zip Code:31098-5000
Practice Address - Country:US
Practice Address - Phone:478-327-8398
Practice Address - Fax:478-327-8400
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2363103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical