Provider Demographics
NPI:1861742363
Name:WHITESIDE, STEPHANIE KRISTIN (LCSW)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:KRISTIN
Last Name:WHITESIDE
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 1:2099 S MORGANTOWN RD
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-9406
Mailing Address - Country:US
Mailing Address - Phone:812-345-2205
Mailing Address - Fax:
Practice Address - Street 1:1700 W SMITH VALLEY RD STE C1
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-1589
Practice Address - Country:US
Practice Address - Phone:812-345-2205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-12
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34006555A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical