Provider Demographics
NPI:1881920031
Name:STEVENS, XUAN (PHD)
Entity type:Individual
Prefix:DR
First Name:XUAN
Middle Name:
Last Name:STEVENS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 291725
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129-1725
Mailing Address - Country:US
Mailing Address - Phone:386-243-5228
Mailing Address - Fax:877-601-7246
Practice Address - Street 1:132 BUSINESS CENTER DR STE A
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-6631
Practice Address - Country:US
Practice Address - Phone:386-243-5228
Practice Address - Fax:877-601-7246
Is Sole Proprietor?:No
Enumeration Date:2009-10-22
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7888103T00000X, 103TC0700X
FLPY 7888103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling