Provider Demographics
NPI:1972190049
Name:STEVENS-FRIPP, WANNETTE RENEE'
Entity Type:Individual
Prefix:
First Name:WANNETTE
Middle Name:RENEE'
Last Name:STEVENS-FRIPP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13910 SILVER DART PL
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-7261
Mailing Address - Country:US
Mailing Address - Phone:678-596-7375
Mailing Address - Fax:
Practice Address - Street 1:13910 SILVER DART PL
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28278-7261
Practice Address - Country:US
Practice Address - Phone:678-596-7375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-23
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0153851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical