Provider Demographics
NPI:1184270951
Name:STEVERSON, JUDITH M
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:M
Last Name:STEVERSON
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 1:13663 PROVIDENCE RD # 355
Mailing Address - Street 2:
Mailing Address - City:WEDDINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28104-9373
Mailing Address - Country:US
Mailing Address - Phone:704-258-0405
Mailing Address - Fax:
Practice Address - Street 1:120 UNIONVILLE INDIAN TRAIL RD W STE C100
Practice Address - Street 2:
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-5670
Practice Address - Country:US
Practice Address - Phone:704-438-9901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-16
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0138191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCPO119131OtherNOT ELIGIBLE TO FILE FOR MEDICARE TO BILL