Provider Demographics
NPI:1457030041
Name:STEVENS, KAITLIN PAIGE (COUNSELOR)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:PAIGE
Last Name:STEVENS
Suffix:
Gender:F
Credentials:COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 DEER PEN RD
Mailing Address - Street 2:
Mailing Address - City:WINNFIELD
Mailing Address - State:LA
Mailing Address - Zip Code:71483-6417
Mailing Address - Country:US
Mailing Address - Phone:318-532-9390
Mailing Address - Fax:
Practice Address - Street 1:560 DEER PEN RD
Practice Address - Street 2:
Practice Address - City:WINNFIELD
Practice Address - State:LA
Practice Address - Zip Code:71483-6417
Practice Address - Country:US
Practice Address - Phone:318-532-9390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5553101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)