1831870468 NPI number — BIANCA SAMONE STEVENS-VINES MSW, LCSWA

Table of content: BIANCA SAMONE STEVENS-VINES MSW, LCSWA (NPI 1831870468)

General
Organization/Personal Information
Provider's Other Name Information
NPI Number Information
Provider's Business Mailing Address
Provider's Practice Location Mailing Address
Additional Information
Authorized Official
Provider Taxonomy Codes
Other Provider's Identifiers (legacy, non-NPI)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831870468 NPI number — BIANCA SAMONE STEVENS-VINES MSW, LCSWA

Organization/Personal Information

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:
STEVENS-VINES

Provider First Name:
BIANCA

Provider Middle Name:
SAMONE

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:
MSW, LCSWA

Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:
STEVENS

Provider Other First Name:
BIANCA

Provider Other Middle Name:
SAMONE

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:
MSW,LCSWA

Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1831870468

Entity Type Code:
Individual

Replacement NPI:

Last Update Date:
07/27/2023

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1485 YELLOW RIBBON DR APT C

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:
FAYETTEVILLE

Provider Business Mailing Address State Name:
NC

Provider Business Mailing Address Postal Code:
28314-3129

Provider Business Mailing Address Country Code:
US

Provider Business Mailing Address Telephone Number:
757-629-4266

Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
690 N REILLY RD

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:
FAYETTEVILLE

Provider Business Practice Location Address State Name:
NC

Provider Business Practice Location Address Postal Code:
28303-5724

Provider Business Practice Location Address Country Code:
US

Provider Business Practice Location Address Telephone Number:
833-846-3463

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:
07/27/2023

Additional Information

			
		

Authorized Official

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

Provider Taxonomy Codes

Taxonomy code: 1041C0700X , with the licence number: P019512 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .