Provider Demographics
NPI:1871789511
Name:JOHN, EMMANUEL STEVEN (LCSW)
Entity type:Individual
Prefix:MR
First Name:EMMANUEL
Middle Name:STEVEN
Last Name:JOHN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1809 W LAKEVIEW DR APT 4
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-4341
Mailing Address - Country:US
Mailing Address - Phone:423-302-0338
Mailing Address - Fax:123-302-0338
Practice Address - Street 1:1809 W LAKEVIEW DR APT 4
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-4341
Practice Address - Country:US
Practice Address - Phone:423-302-0338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-17
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD127121041C0700X
TN57521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical