Provider Demographics
NPI:1356981427
Name:STEVENSON, DANIELA ALESSANDRA (LMT)
Entity type:Individual
Prefix:
First Name:DANIELA
Middle Name:ALESSANDRA
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 BURNS ST
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23669-4610
Mailing Address - Country:US
Mailing Address - Phone:619-994-8564
Mailing Address - Fax:
Practice Address - Street 1:29 SOUTH MALLORY STREET
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23663-2366
Practice Address - Country:US
Practice Address - Phone:619-994-8564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-07
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA576578-09225700000X
VA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist