Provider Demographics
NPI:1225619935
Name:TOADVINE, STEFANIE TANJA (LCSW)
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:TANJA
Last Name:TOADVINE
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 1:530 MAIN ST STE C
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:KY
Mailing Address - Zip Code:40361-1855
Mailing Address - Country:US
Mailing Address - Phone:859-707-5940
Mailing Address - Fax:
Practice Address - Street 1:530 MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:KY
Practice Address - Zip Code:40361-1855
Practice Address - Country:US
Practice Address - Phone:859-707-5940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-15
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2555981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical