Provider Demographics
NPI:1891743415
Name:POE, STEPHANIE LYNN (LCSW)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LYNN
Last Name:POE
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 1:830 SULLINS ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24201-4193
Mailing Address - Country:US
Mailing Address - Phone:276-696-7898
Mailing Address - Fax:
Practice Address - Street 1:830 SULLINS ST
Practice Address - Street 2:SUITE 3
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24201-4193
Practice Address - Country:US
Practice Address - Phone:276-696-7898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35251041C0700X
VA09040048171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical