Provider Demographics
NPI:1174905160
Name:STEVENSON, NOVIA CHANTEL (LCSWA, LCASR)
Entity type:Individual
Prefix:MISS
First Name:NOVIA
Middle Name:CHANTEL
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:LCSWA, LCASR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:336-718-7250
Mailing Address - Fax:336-718-7260
Practice Address - Street 1:140 KIMEL PARK DR STE 200
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103
Practice Address - Country:US
Practice Address - Phone:336-718-7250
Practice Address - Fax:336-718-7260
Is Sole Proprietor?:No
Enumeration Date:2015-06-25
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0096571041C0700X
NCC0108801041C0700X
NC101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)