Provider Demographics
NPI:1538374020
Name:STEVENS, FRED ANTHONY (PCC, LICDC)
Entity type:Individual
Prefix:MR
First Name:FRED
Middle Name:ANTHONY
Last Name:STEVENS
Suffix:
Gender:M
Credentials:PCC, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 ROCKSIDE ROAD
Mailing Address - Street 2:SUITE 113
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-2713
Mailing Address - Country:US
Mailing Address - Phone:216-741-0589
Mailing Address - Fax:216-741-0695
Practice Address - Street 1:1440 ROCKSIDE ROAD
Practice Address - Street 2:SUITE 113
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44134-2713
Practice Address - Country:US
Practice Address - Phone:216-741-0589
Practice Address - Fax:216-741-0695
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE-0003534101YA0400X, 101YM0800X, 101YP2500X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist