Individual
STEPHANIE IRENE BRAVEEAGLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
112 N LIBERTY ST, JACKSON, TN 38301-6200
(731) 610-8862
Mailing address
112 N LIBERTY ST, JACKSON, TN 38301-6200
(731) 610-8862
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
7802
TN
Other
Enumeration date
09/15/2021
Last updated
09/15/2021
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