Provider Demographics
NPI:1295257525
Name:STEVENS, JAMES LEON (LMSW, CAADC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:LEON
Last Name:STEVENS
Suffix:
Gender:M
Credentials:LMSW, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27355 DAYTON RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:MI
Mailing Address - Zip Code:48062-3217
Mailing Address - Country:US
Mailing Address - Phone:586-484-4345
Mailing Address - Fax:
Practice Address - Street 1:80811 MAIN ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:MI
Practice Address - Zip Code:48041-4710
Practice Address - Country:US
Practice Address - Phone:586-315-1880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-07
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011154751041C0700X
MI68011028541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty