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General NPI Number Information
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NPI Number | 1104279462
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Entity Type | Individual
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Provider Name | KRISTEN STICE LMSW
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Gender | Female
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Dates
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Enumeration Date | 07/21/2016
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Last Update Date | 07/26/2019
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Provider Practice Location Address
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Address Line | 6110 SHALLOWFORD RD
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City | CHATTANOOGA
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State | TN
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Zip | 37421
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Country | US
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Telephone | 423-491-1031
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Fax |
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Provider Business Mailing Address
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Address Line | 6110 SHALLOWFORD RD
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City | CHATTANOOGA
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State | TN
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Zip | 37421-1894
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | LSW0000010829
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License Number State | TN
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