Provider Demographics
NPI:1962922120
Name:COLEY, STEPHANIE M (LCSW)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:M
Last Name:COLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:557 W PARK PL
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:TN
Mailing Address - Zip Code:38340-2027
Mailing Address - Country:US
Mailing Address - Phone:731-989-1007
Mailing Address - Fax:731-989-0704
Practice Address - Street 1:557 W PARK PL
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:TN
Practice Address - Zip Code:38340-2027
Practice Address - Country:US
Practice Address - Phone:731-989-1007
Practice Address - Fax:731-989-0704
Is Sole Proprietor?:No
Enumeration Date:2017-06-20
Last Update Date:2022-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11219104100000X
104100000X
TN72601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker