Provider Demographics
NPI:1083625438
Name:PRICE-LEWIS, STACEY ARNETT (MSW,CMSW)
Entity Type:Individual
Prefix:MS
First Name:STACEY
Middle Name:ARNETT
Last Name:PRICE-LEWIS
Suffix:
Gender:F
Credentials:MSW,CMSW
Other - Prefix:MRS
Other - First Name:STACEY
Other - Middle Name:ARNETT
Other - Last Name:PRICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW,CMSW
Mailing Address - Street 1:9305 STATE LINE RD
Mailing Address - Street 2:APT. 23 F
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-3727
Mailing Address - Country:US
Mailing Address - Phone:901-870-6971
Mailing Address - Fax:
Practice Address - Street 1:1030 JEFFERSON AVE
Practice Address - Street 2:VAMC SOCIAL WORK SERVICE
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-2127
Practice Address - Country:US
Practice Address - Phone:901-523-8990
Practice Address - Fax:901-577-7427
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNCSW0000006617104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNCSW0000006617OtherCMSW LICENCE