Provider Demographics
NPI:1821272444
Name:WEATHERSTONE, STEPHANIE SWAIN (LCSW)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:SWAIN
Last Name:WEATHERSTONE
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 1:109 NORTHSHORE DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919
Mailing Address - Country:US
Mailing Address - Phone:865-384-6963
Mailing Address - Fax:865-251-1151
Practice Address - Street 1:109 NORTHSHORE DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919
Practice Address - Country:US
Practice Address - Phone:865-384-6963
Practice Address - Fax:865-251-1151
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-18
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
TNLSW00000054971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker