Provider Demographics
NPI:1811241219
Name:HARNESS-GAMBILL, STEPHANIE ANN (PHD, LCSW)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:ANN
Last Name:HARNESS-GAMBILL
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 EBENEZER RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-5310
Mailing Address - Country:US
Mailing Address - Phone:865-438-7898
Mailing Address - Fax:865-693-7454
Practice Address - Street 1:323 EBENEZER RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-5310
Practice Address - Country:US
Practice Address - Phone:865-438-7898
Practice Address - Fax:865-693-7454
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN61291041C0700X
TN6490 (LMSW)104100000X
TN6190 (LCSW)1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker