Provider Demographics
NPI:1366606782
Name:STEPHENS, LAVERNE HENRY
Entity type:Individual
Prefix:
First Name:LAVERNE
Middle Name:HENRY
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 E 32ND ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23224-1908
Mailing Address - Country:US
Mailing Address - Phone:804-901-1499
Mailing Address - Fax:804-308-8577
Practice Address - Street 1:48 E 32ND ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23224-1908
Practice Address - Country:US
Practice Address - Phone:804-901-1499
Practice Address - Fax:804-308-8577
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services