Provider Demographics
NPI:1780378604
Name:GODMAN, STEPHANIE Y (LCSW)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:Y
Last Name:GODMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1167 SPRATLIN PARK DR
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-6205
Mailing Address - Country:US
Mailing Address - Phone:234-673-6004
Mailing Address - Fax:423-467-3644
Practice Address - Street 1:401 HOLSTON DR
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37743-3127
Practice Address - Country:US
Practice Address - Phone:423-639-1104
Practice Address - Fax:423-636-8365
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-05
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000084831041C0700X
TN84831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical