Provider Demographics
NPI:1386519478
Name:STEVENS, ROBERT (LMSW)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:STEVENS
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1396 TUGALOO DR NE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-3948
Mailing Address - Country:US
Mailing Address - Phone:917-459-4035
Mailing Address - Fax:
Practice Address - Street 1:6425 POWERS FERRY RD
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30339-2908
Practice Address - Country:US
Practice Address - Phone:866-922-2089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-08
Last Update Date:2025-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW012708101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty