Provider Demographics
NPI:1376378588
Name:STEVENS, CATHERINE ELAINE (EDS)
Entity type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:ELAINE
Last Name:STEVENS
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 PINE ISLAND QUAY
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-7191
Mailing Address - Country:US
Mailing Address - Phone:301-346-6713
Mailing Address - Fax:
Practice Address - Street 1:1421 KRISTINA WAY
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-8917
Practice Address - Country:US
Practice Address - Phone:757-494-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAPPS-532400103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool