Provider Demographics
NPI:1467113985
Name:STEVENSON, KIMBERLY J (LCSW)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:J
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 E BROADWAY AVE STE 1203
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-3371
Mailing Address - Country:US
Mailing Address - Phone:701-934-1775
Mailing Address - Fax:
Practice Address - Street 1:3333 E BROADWAY AVE STE 1203
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-3371
Practice Address - Country:US
Practice Address - Phone:701-934-1775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-06
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4058104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker