Provider Demographics
NPI:1265727291
Name:STEVENSON, LLC
Entity type:Organization
Organization Name:STEVENSON, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:WARREN
Authorized Official - Last Name:STEVENSON
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:304-859-4417
Mailing Address - Street 1:1 CANTLEY DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25314-1089
Mailing Address - Country:US
Mailing Address - Phone:304-859-4417
Mailing Address - Fax:304-859-4417
Practice Address - Street 1:1 CANTLEY DR
Practice Address - Street 2:SUITE 2
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25314-1089
Practice Address - Country:US
Practice Address - Phone:304-859-4417
Practice Address - Fax:304-859-4417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV417251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health