Provider Demographics
NPI:1831870468
Name:STEVENS-VINES, BIANCA SAMONE (MSW, LCSWA)
Entity type:Individual
Prefix:
First Name:BIANCA
Middle Name:SAMONE
Last Name:STEVENS-VINES
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:BIANCA
Other - Middle Name:SAMONE
Other - Last Name:STEVENS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW,LCSWA
Mailing Address - Street 1:1485 YELLOW RIBBON DR APT C
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-3129
Mailing Address - Country:US
Mailing Address - Phone:757-629-4266
Mailing Address - Fax:
Practice Address - Street 1:690 N REILLY RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-5724
Practice Address - Country:US
Practice Address - Phone:833-846-3463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0195121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical