1083625438 NPI number — MS. STACEY ARNETT PRICE-LEWIS MSW,CMSW

Table of content: MISS IAYISHA RENEA HIGGINBOTHAM (NPI 1780972919)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083625438 NPI number — MS. STACEY ARNETT PRICE-LEWIS MSW,CMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRICE-LEWIS
Provider First Name:
STACEY
Provider Middle Name:
ARNETT
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW,CMSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PRICE
Provider Other First Name:
STACEY
Provider Other Middle Name:
ARNETT
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW,CMSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1083625438
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9305 STATE LINE RD
Provider Second Line Business Mailing Address:
APT. 23 F
Provider Business Mailing Address City Name:
OLIVE BRANCH
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38654-3727
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-870-6971
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1030 JEFFERSON AVE
Provider Second Line Business Practice Location Address:
VAMC SOCIAL WORK SERVICE
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38104-2127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-523-8990
Provider Business Practice Location Address Fax Number:
901-577-7427
Provider Enumeration Date:
08/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  CSW0000006617 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CSW0000006617 . This is a "CMSW LICENCE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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