Provider Demographics
NPI:1861232514
Name:STEVENS, JENNIFER BUCK (MS, LCMHCA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:BUCK
Last Name:STEVENS
Suffix:
Gender:F
Credentials:MS, LCMHCA
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:BUCK
Other - Last Name:STEVENS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, LCMHCA
Mailing Address - Street 1:9709 WATERTON CT
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-5920
Mailing Address - Country:US
Mailing Address - Phone:704-756-3307
Mailing Address - Fax:
Practice Address - Street 1:18121 W CATAWBA AVE
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-5641
Practice Address - Country:US
Practice Address - Phone:704-756-3307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA19140101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health