Individual
JANICE S FREDERICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
919 MEDICAL PARK DR, MOUNTAIN CITY, TN 37683-1042
(423) 282-1480
(423) 928-1353
Mailing address
119 BOONE RIDGE DR, SUITE 201, JOHNSON CITY, TN 37615-4998
(423) 282-1480
(423) 928-1353
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW0000003418
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3699273
—
TN
Enumeration date
07/15/2006
Last updated
05/05/2015
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