Provider Demographics
NPI:1811662133
Name:STEVERSON, JAMES ALLEN SR (LCSW)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ALLEN
Last Name:STEVERSON
Suffix:SR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4000 BREEZEPORT WAY
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-3739
Mailing Address - Country:US
Mailing Address - Phone:757-739-0269
Mailing Address - Fax:
Practice Address - Street 1:4000 BREEZEPORT WAY
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-3739
Practice Address - Country:US
Practice Address - Phone:175-773-9026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040130841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0904013084OtherLCSW