Provider Demographics
NPI:1356658165
Name:STEPHENS, FRED LEWIS (LCSW)
Entity Type:Individual
Prefix:MR
First Name:FRED
Middle Name:LEWIS
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1143 OAK RIDGE TPKE STE 107B
Mailing Address - Street 2:STE 107B, PMB 274
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-6422
Mailing Address - Country:US
Mailing Address - Phone:865-383-0062
Mailing Address - Fax:865-280-3816
Practice Address - Street 1:679B EMORY VALLEY RD
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-7756
Practice Address - Country:US
Practice Address - Phone:865-383-0062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-01
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000062091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical