Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 1510 | SC |
NPI | 1023492253 |
---|---|
Provider Name | Dr. Kristen Stevens |
First Address | Greenville, SC 29615-4609 |
Second Address | Greenville, SC 29615 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2015 |
Last Update Date | 06/03/2019 |