Basic Information
| Provider Information | |||||||||
| NPI: | 1487381448 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STEVENSON | ||||||||
| FirstName: | LOVEDESHIKA | ||||||||
| MiddleName: | POLITE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MHS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11408 LAKE SHERWOOD AVE N STE A | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708160421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1225261714 | ||||||||
| FaxNumber: | 2252501026 | ||||||||
| Practice Location | |||||||||
| Address1: | 2255 S BURNSIDE AVE | ||||||||
| Address2: | |||||||||
| City: | GONZALES | ||||||||
| State: | LA | ||||||||
| PostalCode: | 707374642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2252617143 | ||||||||
| FaxNumber: | 2252501026 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2022 | ||||||||
| LastUpdateDate: | 08/01/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 08/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.