Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | R02162 | MD |
N | 101YP1600X | Pastoral Counselor | D14115-27 | MD |
NPI | 1124489786 |
---|---|
Provider Name | Dr. Michelle Stevens |
First Address | Leesburg, FL 34748-2038 |
Second Address | Leesburg, FL 34748-2038 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2016 |
Last Update Date | 02/12/2016 |