Provider Demographics
NPI:1184270951
Name:STEVERSON, JUDY M
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:M
Last Name:STEVERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CENTERVIEW DR STE 103
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-3712
Mailing Address - Country:US
Mailing Address - Phone:336-617-3152
Mailing Address - Fax:336-793-9095
Practice Address - Street 1:1501 N CHARLOTTE AVE STE C214
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-2525
Practice Address - Country:US
Practice Address - Phone:704-233-7883
Practice Address - Fax:336-793-9095
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-16
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0119311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCPO119131OtherNOT ELIGIBLE TO FILE FOR MEDICARE TO BILL