Provider Demographics
NPI:1932580008
Name:STEVENS, LORRI JEAN (LMSW, CAADC)
Entity Type:Individual
Prefix:MS
First Name:LORRI
Middle Name:JEAN
Last Name:STEVENS
Suffix:
Gender:F
Credentials:LMSW, CAADC
Other - Prefix:MRS
Other - First Name:LORRI
Other - Middle Name:JEAN
Other - Last Name:PAQUETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NONE
Mailing Address - Street 1:22105 GRAND LAKE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-4018
Mailing Address - Country:US
Mailing Address - Phone:313-377-0877
Mailing Address - Fax:
Practice Address - Street 1:22105 GRAND LAKE ST
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-4018
Practice Address - Country:US
Practice Address - Phone:313-377-0877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-15
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIC-02866101YA0400X
MI68010944541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)