Basic Information
| Provider Information | |||||||||
| NPI: | 1205454121 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STEVENS | ||||||||
| FirstName: | SERRINA | ||||||||
| MiddleName: | JANINE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LCSW-A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 278 N CHURCH ST | ||||||||
| Address2: | |||||||||
| City: | OLD FORT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287628917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282310005 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 139 E TRADE ST | ||||||||
| Address2: | |||||||||
| City: | FOREST CITY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280433149 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282877945 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2020 | ||||||||
| LastUpdateDate: | 07/07/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | P014783 | NC | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.