Provider Demographics
NPI:1831893171
Name:STEVENSON, STEVIE DEJUAN
Entity type:Individual
Prefix:
First Name:STEVIE
Middle Name:DEJUAN
Last Name:STEVENSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77711 FLORA RD # 327
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-4103
Mailing Address - Country:US
Mailing Address - Phone:909-726-4030
Mailing Address - Fax:
Practice Address - Street 1:77711 FLORA RD # 327
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-4103
Practice Address - Country:US
Practice Address - Phone:909-726-4030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician