Provider Demographics
NPI:1831275957
Name:STEVENSON, BRENDA (ACSW, LMSW)
Entity type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:ACSW, LMSW
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW, CAAC
Mailing Address - Street 1:3000 MONROE AVENUE, NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49505-3397
Mailing Address - Country:US
Mailing Address - Phone:616-364-5295
Mailing Address - Fax:
Practice Address - Street 1:3000 MONROE AVENUE, NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49505-3397
Practice Address - Country:US
Practice Address - Phone:616-364-5295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010851331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical