Provider Demographics
NPI:1255099156
Name:BOYLES, STEPHANIE SMITH (LCSW)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:SMITH
Last Name:BOYLES
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 1:605 WATAUGA ST
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4447
Mailing Address - Country:US
Mailing Address - Phone:844-215-0811
Mailing Address - Fax:126-288-8395
Practice Address - Street 1:605 WATAUGA ST
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4447
Practice Address - Country:US
Practice Address - Phone:844-215-0811
Practice Address - Fax:888-395-1262
Is Sole Proprietor?:No
Enumeration Date:2021-12-08
Last Update Date:2023-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN86761041C0700X
VA09040154991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical