Provider Demographics
NPI:1881188753
Name:BLICK, STEPHANIE D (LADAC-II)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:D
Last Name:BLICK
Suffix:
Gender:F
Credentials:LADAC-II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 RUSSLEO DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-4430
Mailing Address - Country:US
Mailing Address - Phone:407-491-0883
Mailing Address - Fax:
Practice Address - Street 1:211 DONELSON PIKE STE 108
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37214-2929
Practice Address - Country:US
Practice Address - Phone:407-491-0883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-14
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1305101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)